BP6649BUILDING PERMIT APPLICATIOiV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 6 4 9
(402) 426-4191 Permit
A lication Date: ~.j 7~ Issue Date: ~`~`c~s Permit Fee: $
pp
JOB ADDRESS ~/~,
~ ~
1 . LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2, OWNER AILA S ~~~ J ZIP P~N~~
3 CONTRA ~ , _ MAIL DRESS ~~ PHO~ LICENSE 0.
4, USE OF BUILDING nn //
~j~ oc(O
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StrUCtUre (Including Basement a arage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ 7 ~ ~, ~ (~
1O FIOOdplaln: Floodway Yes^ No ~
Fringe Yes^ 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 _
ACCEPTEp 8Y 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 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 ihecodes/ordinances of the City of Blair and the State of
Nebraska..l n erstand that this permit is void if work is not commenced within 180 days
or is of co ~ eted withi 2 e rs ofd to o/ ssue. Q
SIGN URE WNER/CONTRACTOR OR AUTHORIZED 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)
~ ~ ~ ~ ~ S
Framing Final
Electrical
Rough-in 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 ~ YOUR PERMIT
Comment: Approved By: ~ j
/l,Ll~/Ofti._
POUNDS PRTG: Blel~, NE ~ Rev. 10x91