BP6718BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
CATION
6718
Permit
Issue Date: G~ - ~-~' ~ Cl ~ Permit Fee: $
JOB ADDRESS
~z~3 ~ N , Zr~~-ice
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER MAILADDRESS ZIP PHONE
3 CONTRA~O~ i MAILADDRESS
J~-~~~chm~ N-E~~nc ~ ill ~ ~~.
C~ . ~~x PHONE LICENSEN~
~~ i ~~ ern~~n~+ C~~c~~~ 7~ !~~
USE OFBUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ MOVE ^ REMOVE
^ REPAIR
6. Describe Work: ~C~C~ ~`~ f °Lt ~~/~ C~( L ~~' - ~ `~~ y
~~1'1 ~~ L--
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^ Dev.Permit
10 Floodplain: Friaga 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 _
ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
I 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 understand that this permit is void if work is not commenced within 180 days
' no ompleted within 2 years of d to of issue.
'o?
DATE
Site Plan Attached ^ ComplQte Plans Attached
Approximate Completion Date ~C-~ ~f'l T ~ ,~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ll_~_GS~ ~~ ~nc~-I
~-
N C) .-~4'~S(.~C~fSYV'~
Electrical ~~ v~ ~ ~~
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
~(
f ~;
Rough-in .
_
ABC
Final ~= ~ ~~
Plumbing
Ground Work
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS I YOUR PERMIT
Comment: Approved By: '
~c C',~
sl
POUNDS PRTG: Blelr, NE ',J Rev. 10/B1