BP5946~~ BUILDING PERMITApPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
Application Date: l~-a ~~ ~~ Issue Date: Permit Fee: $
JOBADDRESS
1. LEGAL
DESCR. LOT NO. ~ ~ ~ BLK. TRACT < f ,/I~ I ~
v-J}~ ^ SEE ATTACHED SHEET
2. OWNER ~ AILADDRESS ZIP ~ `~~0 E
L~
3 CONTRA TOR ~ M
r~ LADD SS ° PHONE LICENSE NO.
USE OF BUILDI
4.
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: $ ~ ZC)() • U~
10. Floodplain: Floodway Yes ^ No ^
Fringe Yes^ 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 _
APPI~C~~ AIC~ED BY 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 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 wdes~ordinances of the City of Blair and the State of
Nebr ska. I u derstand that this permit is void if work is not commenced within 180 days
or is of cb eted within 2 years of d e f issue.
Cp
SIG ATURE OF OWNE ONTRACTOR OR A THORIZED AGE T 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
i
F (before finish)
Final '`'` ~` ~~~`~~
ram
ng
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 IS YOUR PERMIT
CATION
5946
Comment: Approve
OUNDS PRTG: Blelr. NE Rev. 109
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1
j.. - _