BP5886BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 8 8 6
(402) 426-4191 Permit
Application Date: Issue Date: 5 2.7 N Permit Fee: $ IW -0: ;
JOB ADDRESS
LEGAL
1 ' DESCR.
LOT NO.
BILK.
TRACT
❑ SEE ATTACHED SHEET
2.OWNER MAIL ADDRESS
l z(O(o' HONE
C
3 CONTRACTOR MAIL ADDRESS PHONE
y
LICENSE NO.
�-Iv 3.30 /r 7
4. USE OF BUILDING
5. Class of Work: ❑ NEW ❑ ADDITION ❑ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
6. Describe Work:G
7. Sq. Footage of Structure (Including Basement and Garage):
8. Change of Use From: Change of Use To:
9, Valuation of Work: $ C)C)0 . c) o
10. Floodplain: FloDdway Yes ❑ No ❑ Dev. Permit
Fringe yes No ❑ BFE
Elev. Cert.
11. Current Zoning: (� L_
12. State Fire Marshall Required: Yes ❑ No0-
13. Special Use Permit Required: Yes ❑ No ❑'
14. Variance Required: Yes E] Nom
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes❑ No ❑ Waiver Approved
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
I 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 by the 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 codeslordinances 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
_grj ae mpleted thi�r7' 2 years of date of issue.
"`�.7--
SIGNATURE OF OWWR/CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ❑ Complete Plans Attacheq ❑
Approximate Completion Date 71 m tm�4 S . /om
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish)
Framing 'may �f`4� Final
Z(��J Electrical
Rough-ilY 1 Jj� Fixtures
Final v Permanent Service
Temporary Service
Rough -in
Final —
Ground Work
Rough -in _
Mechanical
— A\C
Plumbing
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved y:
IOUNDS PRTG: Blelr. NE Rev. 109
Application Date:
BUILDING PERIMITAIPPLICATION
5.23-9'/
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5880
(402) 426-4191 Permit
a 1'd, Inj 4 cfed 14' W 737r -
Issue
,, rIssue Date: 9 L/ Permit Fee: $
JOB ADDRESS �y
a7 1 C rC�(�a/� �� 0 If
Complete Plans Attached ❑
LEGALLOT
1. DESCR.
NO.
BLK.
TRACT
❑SEE ATTACHED SHEET
OWNER �� MAILADDRESS ZIP
2.
- �.�__4
PHONE
CONTRACTOR / MAILADDRESS l PHONE
3.��I� 7W'
LICENSE NO.
4. USE OF BUILDING
Remote
5. Class of Work:NE/W ❑ ADDITION [-]ALTERATION ElREPAIR
❑ MOVE ❑ REMOVE
,/
6. Describe Work: leC-1 1 Cz � � f I�lJC1J (Jo (-Y(-j "f Y
l'i't axO ( �
7. Sq. Footage of Structure (Including Basement and Garage):
(before finish)
8, Change of Use From: Change of Use To:
Final
9, Valuation of Work: $
Electrical
10. Floodplain: Floodway Yes ❑ No ❑ Dev. Permit Elev. Cert.
Fringe Yes[] No ❑ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ❑ Non
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-
I
APPLICATION ACCEPTED I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
I 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 applicationshall not be commenced until I
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
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 is not completed wlt. in 2 years of date of issue.
SIGNATURE OF OWNER/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)
Framing
Final
Electrical
V, d5
Rough -in
Fixtures
Final 01 (-K5Permanent
Service
Temporary Service
Mechanical
Rough -in
I A\C
Final
Ground Work Plumbing
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough -in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE THIS IS YOUR PETIT
Comment: Approved By: 4
POUNDS PRTG: Blelr. NE If Rev.10191
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