BP5543BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
^~> C~
Application Date: , ~ ~ Issue Date: ~ `~ ~~ ~ ~ Permit Fee: $
JOB ADDRESS ~ ~ ,t, -7
O')` / _ ~~ _
1 . LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2. OWN R
~ / ~ ~ p MAILADDRESS ~ ~ ZIP ~
L.L/ C~ ~C'~'~ ~ PHO
r3. CONTRA R -~
~- MAIL ADDRES PHONE f ,, LICENSE NO.
~~~(/
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
7. sq. FOOtage Of StrUCtUre (Including Basement end Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~-
10. Floodplain: Floodway Yes ^
Fringe Yes^ No ^ Dev. Permit Elev. CeA.
No ^ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
Site Plan Attached ^ Complet Plan~ttached
Approximate Completion Date ~ ~ ~ ~~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
ACCEPTED ~Y I PLANS CHECKED BY I APPROVED FOR~IJANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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 City of Blair and the State of
Nebraska. I and d that th's permit is v id if work is not commenced within 180 days
or's n t ce ete i~ ars f-~ of issue.
SIGNATURE OF OWNERiCONTRACTOR OR AUTHORIZED AG DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Septic
Remote
Building
Footings Drywall
(before finish)
Framing ~ Final G 2p
Electrical
Rough-in ~ Fixtures
Final c~ Permanent Service
Temporary Service
Rough-in
Final .
Mechanical
ABC
Plumbing
Ground Work ~/
Rough-in ~~1 cx~.P tyro-+~J ? GY7 Final ~~'
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS 1~OUR PERMIT
5543
Comment: App ov~~-~c~
~I1N0S PRTC -Rlelr. NE RBV. 10/91
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
Application Date: ~ ` ~ („ r`1 ~ Issue Date: ~`~ 7 ~~ Permit Fee: $ ~~C~
JOB ADDRESS ~ `l ~ ~ ~~~~_~
V
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAILADDRESS
2. V ~~ ~~ ~ ` ~19~~. ZIP PHONE
3. CONTRACYOR MAILADDRESS
~n -~~ ~ PHONE ~
~~~ 27~ ~ ~ ~ , LICENSE NO.
~ y~~~>~5~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ G ~ ~~~'Y~ ('~ ~,~,~ ~ ~~L2-/~- C' ~ ~~ yy~ ~
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes^ No ^ Dev.Permit
Fringe Yes^ No ^ BFE
EIev.Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
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
Separa a permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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 acopyof this application form signed bythe 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 City 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 r~pleted wi~in 2 years of date oirissue.
OF OWNERfCONTRACTOR OR
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
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work ~ /~,
SIGNATUREOFOWNER(IFOWNERBUILDER) DATE I Rough-in ~ ~~~~ Final [~l.l
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
7S PRTG: Blelr, NE
5539
Rev. 7091