BP6424BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
6424
Permit
Application Date: ''/ " l ~- `f S Issue Date: ~-~ I Cl S ~ Permit Fee: $ ~ E
JOB ADDRESS I „ ~j~ /~ ( I 1 C ~(. S ~
lfJ Q 1 1°~ ~ .
LEGAL
1 LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
' DESCR.
2. OWNER , 1 r' ~ ~~~ MAIL ADDRESS
~-} Vl ZIP PHONE
MAIL A ESS
CONTRALTO PHONE LICENSE N .
USE OF BUILDING
4.
5. Class of Work: ~^ NEW ^ ADDITION ALTERATION ^ REPAIR r VE ^ REMOVE
6. Describe Work: ~CK ~ .~~? m +U ~~ ~ ~ ~( ~ ~ G ~~
7. Sq. Footage of Structure (mclDding BBSement ana Garage): •~~
~ C-~l r
(~ ~ C ~~ ~(' ~ Q ')
_ ~yS
8. Change of Use From: ~~ a of se To: ~ ~-- ~'d
g, Valuation of Work: $ ~9 ~ ~~~
10. Floodplain: FlDOaway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert. ~~
11. Current Zoning: ~~ ~
12. State Fire Marshall Required: Yes ^ No[fi
13. Special Use Permit Required: Yes ^ No
14. Variance Required: Yes^ No[~
15. Minimum Setbacks: Front Side ,~_ Ream
16. Sidewalk Required: Yes ^ No [.~{-W"aiver Approved
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
(~- ZS' ~(S -S OrNi1rJ
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 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
Nebrask derstand that this ermit is void if work is not commenced within 1 SO days
or is not com eted within 2aeark of issue. ~,
SIGNATURE OF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE
Footings Drywall
(before f finish)
Framing Final '~ 11 _fU°~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
Final -
Ground Work
CATION
Building
Mechanical
- ABC
Plumbing
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough-In Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: App ved By
'OUNDS PRTG: Blab, NE Rev. 109
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address Date
Legal Description: Lot 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? __
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'~ Pro ert Line
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_ _Center Line_of _ _ _
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Indicate North
Applicant
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