BP6147BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
6147
Application Date: I U - ? H _q _I Issue Date: ) () _Z- -Ql L/ Permit Fee: $ (�,, on
JOB ADDRESS
LEGALLOT
1 ' DESCR.
NO.
BLK•
TRACT
❑SEE ATTACHED SHEET
OWNER MAIL ADDRESS ZIP
2. E� -� rl �_ Qwb1IsHU� (5c�me
PHONE
CONTRAC R [L� MAILADD ESS PHONE
3.'fox i ��'
Z C J) 1 C A (nom L- �
LICENSE NO.
Fre��n
4. USE OF BUILDING
7 2-1— &SCg
5. Class of Work: [NEW ❑ ADDITION ❑ALTERATION ❑ REPAIR
❑ MOVE []REMOVE
6. Describe Work: -_(/l r r)a — 15 0 QCT C) 670 U Rc rnn L_Q_
7, Sq. Footage of Structure (Including Basement and Garage):
8, Change of Use From: Change of Use To:
9, Valuation of Work: $
10. Floodplain: Floodway Yes ❑ No ❑ Dev. Permit Elev. Cert,
Fringe Yes No ❑ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ❑ NOD
13. Special Use Permit Required: Yes ❑ No ❑
14. Variance Required: Yes ❑ No ❑
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes E] No ❑ Waiver Approved-
APPLICATION
pproved_
APPLICATION ACCEPTED 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 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 n)yompleted within 2 years of dao issue.
P, fa —4,L & -
AGENV DATE
Site Plan Attached ❑ Complete Plans Attached ❑
Approximate Completion Date I I - Z _q
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish)
L ct -9
Framing Final i Y
Electrical
Rough -in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough -in A\C _
Final 6.00
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough -in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS I YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blair, NE // Rev. 10)81