BP5593BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
`~ 218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date < ~~~ ~y
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Application Date: ~(~ `~ ~"~~, j Issue Date: I (~ ' ~U' ~ Permit Fee: $ ~C) ~ C~
JOB ADDRESS r
~~Q ~~U~~ I SR7
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER f ~S t ~ ~~~ ~~ 1?A DRESS ~ ZIP PHONE
(
MAILADDRESS PHONE LICENSE NO.
CONTRACTOR /
3. _ ~~~ ens Cep f~ C • ~~~C~ ~~~~ ~- ~~~ - ~~ ~~
4. USE OF BUILDING
5. Class of Work: ~~NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~C~C ~. ~~~ 7~~/C . ~ y~ `5~j ~~~
], Sq. FOOtage Of StrUCtUre (Including Basement end Garage): ~ l
( ~i` `; /~ X ~ L
C.'
$. Change of Use From: Change of Use To:
g, Valuation of Work: $ i" ~~ ,
Floodway Yes^ No ~~' Dev.Permit
10. Floodplain: Fringe Yes^ No ^'~ 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~Vllaiver Approved
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
aska. I understand that this permit is void if work' of commence within 180 days
or' not complet~iiSj~in 2 years of date of issye~
OF OWNERIC,yIQTRACTOR OR AUTH(~IZED~GENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Footings
Framing
CATIO~IV
Building
Permit 5 5 9 3
Drywall
(before finish) r f
Final ~~ Z (~ `L
Electrical
Rough-in Fixtures
Final r~ 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
Comment: Appr v~d y ~ „~
_e~.-~_
'OUNDS PRT(i: BIaIr, NE Rev. 10rB
l.i~~ti~ ~LhV~YuK'~ v~:n'i ~~=1vh'i is
LEGAL DESCRI~ION:
LOT I , K-SPAN INDUSTRIAL PARK'SU6DIVISION~ BLAiF31 NEBRASKA,
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c~~ i FAT `~~~ ~~Y
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Q c Pin• Found
• V2~~x 20~~Rebar Sel
3/4° Pinch !oo aloe
I/2~ Rebar
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S gl°'S"S '~0' w '`
5/8"Rebar 251.08 I
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CITY INSPECTION SLIPS
Inspection has been requested for Locat n(o Building
Na of Company
On ~ C ~
fType of Z pect
At ~~ /~ I~3
Date
ion
~~ ~~
Time
Results of the Inspection are:
~.
~ ty Representative