BP5600BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATIOrI
Permit 5 6 0 0
Application Date: ~~ - 2~, - Q 3 Issue Date: f <~ ~ ~/
) ~ ' ~~~' ` ~ J Permit Fee: $
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2. OWE MAI DRESS Zlp PHONE
3. CONTR CTOR ~ ~ ~ MAIL AD' ~ ES§ y r ~ ,P#iON~~ m
(~~, ~~ ~T ~CENSE NO. - 7 1 2
V L IJ
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: A v a C
7. Sq. Footage of $trUC1Ure (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
112 FIOOdplaln: Floodway Yes^
Fringe Yes^ No ^
No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~ O / ~ 1 ~ ~~
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^
sewer water service
15. Minimum Setbacks: Front Side Rear septic Remote
16. Sidewalk Required: Yes^ No ^ Waiver Approved z Z~~~ - No c~l_
Building ~~ $.~,~
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
NOTICE Framing Final
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 Electrical
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 Rough-in FlXtures
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 Final Permanent Service
above and in accordance with the codes~ordinances of the City of Blair and the State of Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not I~mpleted within 2 years to of is e. Mechanical
Rough-in ABC
IGNATURE OF OWNERICONTRACTOR OR AUTHORIZED AGENT DATE Final ~ ~~
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d B
'OUNDS PRTO: Blab, NE Rev. 10)9'