BP5888BUILDING PERMITApPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
5888
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Application Date: ~ Zl_ ~L/ Issue Date: ~~~-~ ~ "~ ~ Permit Fee: $
JOB ADDRESS
O ~ ~ ~G(-'~.l t S
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
®SEE ATTACHED SHEET
2, OWNER p MAILADDRESS ZIP PHONE
`~10~ ~ ~fi.i2~r~ 4 -~f5~ A~~ ~
3, CONTRACTOR ~j~ ~ MAIL ADDRESS PHONE LICENSE NO.
~~/ZL r 1-Cti-1~<~c
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ®REMOVE
6. Describe Work: ~ - ~~S `~C~.-~-~ - C~(f ~r'I9 1~ ~ ~G~
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $~~'~~ ~~
Floodway Yes^ No ^ Dev.Permit
10. Floodplaln: Fringe Yes^ No ^ 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 _
8Y 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 acopyof this application form signed bythe 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~pleted within 2 years of date of issue.
TURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~`lU ~l`~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~ ~r ~~
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
Comment: Approved~y~~~~~ ~~
CATIO~iV
POUNDS PRTG: Blelr, NE /~ Rev. 10/91