BP5718BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
5718
) Irr so
Application Date: ~ ~~ 1~9~f' Issue Date: Permit Fee: $ ~
JOB ADDRESS .I ~ ~ \ ~ ~ _ ~ j
1 ' DESCR. LO~L ~~ ~ BLK. TRACT I ~ f ~ ~ _ I ~ ^ SEE ATTACHED SHEET
2. OWNER ~ ~~ MA DRESS ZIP ~~~ ~ ~~O PHONE
3 CONTRAC R MAILADDRESS P NE II rr LICENSE NO.
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~, ~~ ~~
7. Sq. Footage of Structure (Ind~aing Besemenl and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~~~~
11J Floodplain: Floodway Yes ^ No ^ Dev. Permit
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 ^ Waiver Approved _
APPLICATION ACCEPTED 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 permitapplication 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 acxordance with the codesJordinances 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 completed within 2 years of date of issue. -
SIGNATURE OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~~I ~'
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish) ~/
~ ~~9
Framing Final
!
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
CATION
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
Rough-in Final ,
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro By
~~
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