BP5416BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~' ~ " ~~ Issue Date: ~' ~' ~~ Permit Fee: $ ~ o~
JOB ADDRESS ~ ~ ~ 1 ~ ^ c
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER ~'
2. MAILADDRESS ZIP PHONE
CONTRACTOR
3. - M IL ADDRESS PHONE ~• LICENSE No.
~~ ~ S~ /~'L ~~. E Gt~v-t
4, USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Flaodway Yes ^
10. Floodplain: Fringe Yes^ No ^
No ^ Dev. Permit
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 _
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date 7 ' ~' S''Z
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
ZS-ct~r- Nd ~ ~
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate per its are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge 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 acxordance with the codes~ordinances of the City of Blair and the State of
Nehfaska. I understand that this permit is void if work is not r,o menced within 180 days
plet d within 2 yea of date.of ' ue.
;~
IGNATURE OF OWNERJCONTR R OR AUTHO IZED AGENT DATE
Footings Drywall -
(beforefinish)
Framing Final
Electrical
Rough-in
Final _
Temporary Service
Rough-in
Final -
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE)'-THIS IS YOUR`F'ERMIT
Comment: Approved B
POUNDS PRTG: Bleb, NE ReV. 10J81
CATION
Building Z " o , „ ~l a ,
Permit 5 416
Fixtures
Permanent Service
Mechanical
- ABC