BP6737BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
a -~ ~~5-- Issue Date: 4 ~ ~~ ~~
CATIOiV
Permit 6 7 3 7
Permit Fee: $ ~
JOB ADDRESS
LEGAL
1, DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER `n~i~t~ ~~~/~ ~~/,n ~MAILADDRGS~ ~` /~, /,~ ZIP PHONE
Y-'/ ~J
V
PHONE LICENSE N0.
MAIL ADDRESS
3. CONTRACTOR
4, USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~, ~.J ~~~~
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ ~ ~ ,_ C ~
10. Floodplain; Floodway Yes^ No ^ Dev. Permit Elev. Cert.
Fringe Yes^ No ^ 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. Sidgwalk Required: Yes ^ No ^ Waiver Approved _
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
( NOTICE
Separat 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 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
raska. I understand that this permit is void if work is not commenced within 180 days
r is t completed i years bf dot of issue.
SIGNATU 0 ER/CONTRACTOR OR AUT I AGENT 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
Final
Temporary Service
Rough-in
Final
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS
Comment: Approved By: ~, ~~
Fixtures
Permanent Service
Mechanical
ABC _
Plumbing
Final
R PERMIT
POUNDS PRTG: Blair, NE _ /~ Rev. 10/91