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BP5773BUILDING PERMIT APPLICATION .Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit_ 5773 _ ~ J dC) Application Date: ~ ` ~~ ~ ~ Issue Date: ~ ~~ ~ ~ J Permit Fee: $ JOB ADDRESS ,1 // ~ C~r~'w' / _ - _ 1 ` ~! ~ J ~,J (~M' l ~ ~ C.~L~C~ LEGAL 1 ' DESCR. O. LOT N B LK. TRACT ^ SEE ATTACHED SHEET 2 OWNER ~ /~Q~ ~ ;~ MAILADDRESS ZIP PHONE 3, CONTRACTOR ~ ~i MAILC DDRESS ~ C ~ `~ / %,/.~Q PHONE J / I`~ ~~ ~ ~ ~ LICENSE N0. ll~dl USE OF BUILDING 4. 5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: ~~ ~1 ~~~I `n C-~~~ ~ ~~~~ 7, Sq. FOOtage Of StrUCture (Including Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ 10. Flood lain: Flooaway Yes ^ No ^ p Fringe Yes^ No ^ Dev. Permil 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 _ APPLICATION ACCEPTED 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, l 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 bythe Building Inspector and stamped 'APPROVED'. I hereby agree to perform the proposed work in accordance with the specifications setforth above and in accordance with the codesJordinances of the City of Blair and the State of ebras . I understand that this permit is void if work is not com enced wit in 180 days o is completed~vit>in ~~yfears ofissue. IG~VATURE OF OWN~~~COI~~ACTOR OR AUTHORIZED AGENT ~ ~ DATE Site Plan Attached ^ Complete Plans Attached ^ Approximate Completion pate Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote 4-2-n~(- sic I I wfUr`K~.r1~ ~ f ~- ~-' Building 5-?.3-R Footings Drywall (before finish) ~ ~~/+~~ Framing Final Electrical Rough-in f ~CJv Fixtures Final ~ Permanent Service Temporary Service Mechanical Rough-in ABC Final Plumbing Ground Work SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: POUNDS PRTG: Blelr, NE Rev. 10/91 i~ - ~~ILDING INSPECTION REPORT _ ~ CTTY_OF BLAIR ^ WASHINGTON COUNTY ^ _ OTHE fR _ ,. LOCATION OF INSPECTION: ~ (~ ~ ~ ~ ~) ~ L. / ~`=-~S ~~ _ ~ f ~ *- NAME OF-OWNER: ~, ~~ ('=`1 ~ RACTOR: - ~ _ DATE INSPECTION REQU ED: '~ t ~ j L ERMIT N0: ``~ TIMEINSPECTIO QUESTED: ' ©• ~J . TYPE OF INSB CTION REQUESTED: BUILDING: -~-~ ~0~ ~-~'I-~~ ~~Q,~7 ^ FOOTING ^ FRAMING DRYWALL ; :_ AL ~ ~ p _ (1 ~ ~, ~ .~ UTILLTIES, <, {"n 't.{, . - ,.`-~ ~ 1s., ^ SEWER TAP ^ SEW.ER : `. ^ SEPTIC ^ W~fiER TAP _ - ,~ - _, ,- ~~. REMOTE ^ WATER SERVICE ` ~ - ELECTRICAL: ~ -" ^ ROUQH IN ^ FIXTURES ^ FINAL ' ^ MOTORS ^ PERMANENT SERVICE ^ TEMPORARY SERVICE MECHANICAL: ^ ROUGH-IN ^ A/C ^ FINAL PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL RESULTS OF THE INSPECTION: ~] PASSED (SEE NOTES) ^ FAILED (sEE rroTES> NOTES/REMARKS: / -