BP5509BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
5509
Application Date: ~ ~~~'~ ~ Issue Date: ~~~~ ~ _~/J ~~ Permit Fee: $ ~ '~ ~J
JOB ADDRESS ~ I X r U ~ ~ ~ ~~U~~ I `UGL.~
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2 OWNER ~,, ^) MAILADDRESS Zlp PHONE
CONTRACTOR
3. ~ /Ssa~ /a~ ~. i-~~-c MAILADDRESS
r ~/C ,~ PHONE .
~~/~~ ~1 S~- ~l,~~a~r~c LICENSE NO.
/~~ C ~iz~ ~7~ -~~,~
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~/ ,~ ~. ~ ~~~ ,~~ ~~
7. Sq. Footage of Structure pnGuaing Besemem ana Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. 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
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Z- ~S-Ry- o c-a.~~.A. `FoY`
Building ~ ~ ~~ ~~
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
Gl/~_
' 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 acopy of this application form signed bythe Building Inspectorand 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
or i not eted jthin 2 years of date of issue.
J ~ ~ ~ - C~~-ice
IGNATURE OF OWNER)~,ll RA TOR OR AUTHORIZED AGENT DATE
~/
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final ~<• ~~ ~
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
CATION
/c9. c~c~
Comment: Approve y~~^-~-'-- ^ ~
u~~ iune ooTr_ _ni-., ue `,'%>~J` Rwv_ 1(110