BP5934r
.~ BUILDING PERMITAPPLI
_. Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~ l ~ ~ Issue Date:
n
Permit
Permit Fee: $ ~G
JOBADDRESS ~ ~ / ~ .l y
(..JS
1. LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
OWNER /
2. ~' r MAILADDRESS Zlp PHONE
3 CONTR @ ~ MAILADDRESS~~ ~ `~ PHONE ENSENO.
4, USE OF B G
5, Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6, Describe Work: ,~ t~,~~
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. FIOOdplaln: Floodway Yes ^
Fringe Yes^ No ^
No ^ Dev. Permit Elev. Cert.
BFE
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 _
TION 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, 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 herebyagree to perform the proposed work in accordance with the specifications setforth
above and in accordance with the codes~ordinances of the Ciry of Blair and the State of
Nebraska. I land th is permit is void if work is not comm aced wi hin 180 days
or is not com lete within y ars of da of issue. / C, _
l
GNATURE D NER/C ACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Comp to lans ach ^
Approximate Completion Date ~/ ~ ~~9~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final t*' ~~"~
Electrical
Rough-in Fixtures
Final ~ Permanent Service ~ ~ ~~
Temporary Service
Mechanical
Rough-in A`C
Final
"" v ' Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPAGEj~THIS IS YOUR PERMIT
CAT10~1V
5934
POUNDS PRTG: Blelr, NE Rav. 10191
9