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BP5370
BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Application Date: (s~ - (~~~ Issue Date: ~ ~ ~ ~ ~ ~ Permit Fee: $ ~~ ` ~ ~ JOB ADDRESS ~ ,{,~ C.C~ /'/' LEGAL 1' DESCR. LOT N0. ~ ~~ BLK. TRACT ~ SEE ATTACHED SHEET ~(i( ~~ OWNER `~ 2. ~ MAILADDRESS `©` ~ y j~ ZIR, /~~ PHONE /I L, 3. CONTRACTOR ~ f ~ ~ rvl MAIL,~IDDRESS 2~Q (/~ ~~ ~~ 1~C~~ ~ ~ LICE/ Y" 7/ / USE OF BUILDING 4. 5. Class of Work: [NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: ~ ~ ~ ~~ ~ _ ~,r'~~ 7. Sq. Footage of Structure pnduding easement and Garage>: $, Change of Use From: Change of Use To: g, Valuation of Work: $ ~sQ ~ . Floodway Yes ^ No 10. Floodplain: Fringe Yes^ No Dev. Permit BFE EIev.CeA. 11. Current Zoning: ~ ~ 12. State Fire Marshall Required: Yes ^ Nod 13. Special Use Permit Required: Yes ^ No [~' 14. Variance Required: Yes ^ No 15. Minimum Setbacks: Front Side Rear 16. Sidewalk Required: Yes ^ No ^ Waiver Approved _ BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY ,~, ~ . -~ NOTICE Separate permits are required for electrical, plumbing, heating, ventilating and air condi- tinning, and septic systems. By my signature below, I achnowledge that payment of the building permit application fee does not constitute issuance of this building permit. I further agree that construction covered by this permit application shall not be commenced until I have received a copy of this application form signed by the Building Inspector and stamped 'APPROVED'. I hereby agree to perform the proposed work in accordance with the specifications set forth above and in accordance with the codes/ordinances of the Ciry of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within 180 days or is not completed within 2 years of date of issue. SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE Site Plan Attached ^ Complete Plans Attached ^ Approximate Completion Date ~'~ Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote - Building Footings Drywall (before finish) ~~ ~ ~~ Framing Final ~ Electrical Rough-in Fixtures Final Permanent Service Temporary Service Rough-in Final - Ground Work Plumbing SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Mechanical - ABC _ Permit 5370 Comment: Approv d B : ~` rr funs oam _wiei. NF RBK fO/B { .~ ' ~~ ',; ~r ~. N Y~^/ r ~~Q M ~~ `~,' ~ ~~ lT n ~ ~}._ 1~~ ~. ,~i,,. P ~~y' ~af- '1 ~ n ~~ 1~ \i ^ '~M~ v 1 x '~ } ~ ~r _ ~-~ ^E a~~ _~ Y fir" t ..` ~. - c^ rd ~ ~ ~ ~ , ~ r`\ ~~~' L~ F ''o ti., w.. •~~ ;a .t"'~~ '4 ' .a w 1 I ~ ~ . ~ 1 y ~' ~` ~ ~ ti ~ ~ ~. s ~ ~ 4 11 v ~ ~ 'r ^~ ~~ U ._ ~, ~ \~ ~. •~ `~ ~`~' i ! w ~~~ \~ o.gy.t: ~""'\ CITY INSPECTION SLIPS tY~, I ~ .~ ~~~~ ~~. Inspection has been requested for ~~ =? ~' Location of Building r ; Name of Company / ~' ~' (Type of Inspection) Date Time ?y~F;Sak.~' . v ~,r~': a Results of the inspection are: ~ ~ ' City resentative ~I