BP5770_ BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
5770
Permit
Application Date: .~- ~ 7~ ~ L~ Issue Date: L~~l 9 / `7~ Permit Fee: $ ~ ~ ~'
JOB ADDRESS i ~ mil"
l ~ , / L_. ~n~' ~ v
1. LEGAL
DESCR. LOT NO. LK. TRACT ^ SEE ATTACHED SHEET
2. OWNER •~ l ~ ~~~ ~ I AIL/~DDRES ~~ ~r, ZIP
I
1 ~~~ ~~O~f-,, ,
~
~
ADDRESS PHONE
MAIL
3. CONTRACTOR LICENSE N
O
.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~ CA_~ F° ~,. ~~ ~1 C~-/Z~L ._ C~C1 ~'~ ~-.~V 1.1 ~ ~-Z- ~ /
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ 1 C~(~,
10. FIOOdplaln: Floodway Yes ^ No ^ Dev. Permit
Fringe Yes^ No ^ BFE Elev. 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
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 copyof 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
~,ebras~. I understand that this permit is void if work is not commenced within 180 days
or\is n6t coMbleted within ors of date of issue.
URE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Wap
Sewer ater~ervice
Septic
Footings Drywall
/ (before finish
Fram g Final ~~ ~ ~
Electrical
Rough-i Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Ap ve B : -,
...............,,, ..,_._ .,~ a,w ~ma
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address
Legal Description: Lot
Date
Block Addition
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot?
v
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a
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a
'' Pro ert Line
x- ; Ex/ST~~U~~ ~6~tCy P
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l~ew
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_ _
_ _Center Line_of _ _ _
Applicant
Street_ _
Indicate North