BP6162`~- BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
6162
Application Date: ~ ~- ~ ~ ~"J Issue Date: ~~-~- l ~l Permit Fee: $ ~ ~ °~U
JOB ADDRESS
t ~~ S Y1~G~S h u'1 ~ ~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ` i j~ ~ ~~~^~
y 1. ILADDRESS ZIP PHONE 7
Z.~, ° ~S G
3. CONTRA R MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: [~j NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~ ~~
]. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): ~ X y ~ /~1 n ~~ / ~ /C~ fn
/
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~'~ ~ ~ C~
10. Floodplain: Flooaway Yes ^ No ^
Fringe Yes ^ No ^ Dev. Permit Elev. Cert.
BFE
11. Current Zoning: G~ /~
12. State Fire Marshall Required: Yes ^ NoLg
13. Special Use Permit Required: Yes ^ No [~
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No [~
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver 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 copyof this application form signed bythe Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
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 1 SO days
or js not,~ompleted within 2 years of date of issue.
OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Sewer
Septic
Footings
Framing
~~'1 '~~
Rough-in ~ / ~ Fixtures
Final Permanent Service
Temporary Service
Rough-in
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
Permit
Water Service
Remote
wilding
Mechanical
- ABC _
Comment: Approve ~""• ~ ti
'OUNDS PRTG: Rlelr. NE .._.....~„
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~RQUGHIN ~ ^FIXTURES.-'FINAL'.MOTORS
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I O PERMANENT SERVICE
~] TEMPORARY SERVICE' -
i .:: MECHANICAL:. ;. - . . .
I ... ^ ROUGH-W ~ A/C ~ ~~ . .
j PLUMBINGc
,_ .
.. - ;
. -
GROUNDWORK
I .
~ -
^ ROUGH-IN a FWAL
RESULTS OF THE INSPECTION; SSED~(sEENOr~s `
'~
~FAILED(s~xoTES~.
..' NOTES/REMARKSc
~ :.INSPECTOR: ~
I DATEOFINSNECTIONIvIAD
E' ~ ~~ ~ ~.
.TIME;
'
CALLED:OPPD\
-
~ .
TO CONNECT-SERVICE.
_ ~~ XES M~]Nb
yV/ANT OFFICE STAFF TQ CALL O PPD\
- -- _ __;_
_ ~ _ _ _„ C~ YES :,: [] NO BLR 1
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