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BP6131 - .BUILDING PERMITAPPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Sewer Application Date: ~ ~ ~ ~ ~ r I y Issue Date: ~ ©'/ ~~ / Y Permit Fee: $ ~5 • d JOB ADDRESS ~~ O `l ~ ~,n ' , ~ l ~ ~ ` - LEGAL 1 ' DESCR. LOTNO. ~ ~ ~ BLK• ~ ~~ TRACT ^ SEE ATTACHED SHEET 2, OWNER ~~ '~(~~~ MAILADDRESS f~~ ~~7 Z P PHONE 3, CONTRACTOR ~ ~ C r ^MAILADDRESS~~ I ~x Y!~'U ~ ~ NE ~~~~~ ~~5~ ~I USE OF BUILDING 4. 5. Class of Work: ~] NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: ~ e G I ~ a ~ ~ u ~ U ~ ~ ! ~ h (/u.S-~~ 7, Sq. FOOtage Of StrUCture (Including Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ 3 ~ 6 (~ ~ 10. Floodplain: FI°°dway Yes^ No ^ Fringe Yes^ No ^ Dev. Permit BFE Elev. Cen. 11. Current Zoning: '~ ~ 12. State Fire Marshall Required: Yes ^ No~ 13. Special Use Permit Required: Yes ^ No 14. Variance Required: Yes ^ No [~ Site Plan Attached ~ Complete Plans Attached ^ Approximate Comp etion Date ~ ~ ~ Inspections Required and Fees Utilities Sewer Tap Water Tap 15. Minimum Setbacks: Front ~~ Side ~ Rear Z~ Septic 16. Sidewalk Required: Yes ^ No ^ Waiver Approved I ~ 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 copyof this application form signed bythe Building Inspector and stamped 'APPROVED'. I herebyagree 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 ,pr is not completed within 2 years of dat~6f issue: SIGNATURE OF OWNERJCONTRACTOR OR AUTHORJ~ElYAGENT DATE SIGNATURE OF OWNER (IF OWNER BUILDER) DATE CATION Permit 6131 Water Service Remote ' 5 2Z~-s°t-+11 Wo„~c~n~~ Building Footings ' Drywall (before finish) Framing ~ ~ I ~~ Final ~l~(0-~C~~- Electrical / vv Rough-in v Ixt res Final ermanent Service Temporary Service Rough-in Final - Mechanical - ABC . Plumbing Ground Work Rough-in Final WHEN PROPERLY VALIDATED (IN TH,~S $P--ACE) THIS IS YOUR PERMIT POUNDS PRTG: Blelr. NE ~ Rev. 1081 CITY OF BLAIR Application for Building Permit PLOT PLAN ~.""` Address ~~ ~.iru~c~~-~~ ~ Date ~~ ~~ r Legal Description: Lot e ~ Block ~ / `> Addition Please show all measurements of existing and contemplated structures, also show distances between structures, etc., and property lines. Is this a corner lot? 4~ ~~~ ~ ,_~L C~ ~~.,~~ ~,~. ~~ I J n.,.,.r..-,,..a-., T.i no ~...~` ,; ~ ~~ a ~~ ~ ~ }~ ~ r__...__n__...___.~_. ~ ;: I r ~ .~ ___,!_ -- LL-~ ~~_ _-~._. 1'~ r111 tf~ ~ fl --~.~,~~ % O .... 1 ~ ~ ~ ~~~ ~ .~>(~ ~~ . ~ ~. '" L~ Indicate North _ _Center Line_of _ _ _ ~ Street_ _ Applicant ~BI~ILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 6 6 5 9 (402) 426-4191 Permit ~,~ - ~ ~ Application Date: ~ r Issue Date: ~~ Permit Fee: $ JOBADDRESS~~ ~ ~G~!/C~~ / T 1 LEGAL DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET 2. pyV MAILADDRESS ZIP PHONE 3 CONT R ~ MAILADDRRESS HO/J ~, L E E USE OF BUILDING 4. 5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: 7. Sq. Footage Of Structure (Including Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ 10. FIOOdplaln: Floodway Yes ^ No ^ Dev. Permit Fringe Yes^ No ^ BFE Elev. Cert. 11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^ 12. State Fire Marshall Required: Yes ^ No^ Approximate Completio n Date Inspections Required and Fees 13. Special Use Permit Required: Yes ^ No ^ utilities Sewer Tap Water Tap 14. Variance Required: Yes ^ No ^ sewer Water service 15. Minimum Setbacks: Front Side Rear septic Remote 16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building APP ATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall (before finish) NOTICE Framing Final 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 Electrical U 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 Rough-in Fixtures have received a copy of this application form signed by the Building Inspector and stamped 'APPROVED'. Final Permanent Service 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 Temporary Service Nebraska. I understand that this permit is void if work is not commenced within 180 days . or is not com leted within 2 years of date of issue. Mechanical ~' ^ ~ Rough-in ABC SIGNATURE OF OWNER~CONTRACTOR OR AUTHO IZED AGENT DATE 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 ~-- ~ ~~. POUNDS PRTG: Blelr, NE Rev. 10191 `C h ~ C7 m ~ n o d ° ~ ~ ~ ~ ~ z o ~ , r b m ~ , d .~ . o II C- 1 o ~ C~ e . 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