BP6630BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
Application Date: ~ -Z ~ ' q~ Issue Date: 7 ~ 2 ~ ~~ Permit Fee: $
JOB ADDRESS ~ ~ ~ ~-7~ /~, Jam,
7", \.
vhf
LEGAL
1 ' DESCR. LOT NO. BLK TRACT
^ SEE ATTACHED SHEET
2. OWNER MAILADDRESS ZIP
~ nn a ~ a col ~~- PHONE
3. CONTRACTOR J~C~' ~~~C~/,~ MAILADDURES~ //~ PHONE Liz l _ ~ ~~~SENO.
T C~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~-2v~~
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. Floodplain: 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 _
BY 1 PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate ermits 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 acopy 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 Ciry 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 ritp eted within 2 years of dat~jof '~s e.
f~ ~-Z~ /'
SIGNATy F OWNERfCONTRACTOR OR A RIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final ~~ C)C~ Permanent Service ~ .~ZX~~
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 OUR PERMIT
Comment: Approved By:
6630
POUNDS PRTG: Blelr, NE // Rev. 1091
r