BP5403--BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit 5 4 0 3
Application Date: ~-~ ~~ Issue Date: Permit Fee: $ / ~, r
JOB ADDRESS I ®/'\l,I ~
lJ ~~~ ~Vl~' IUD
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
~ SEE ATTACHED SHEET
OWNER MAILADDRESS ZIP
2. ~~~ t~' (~-~~Y1 C~a'a'LQ_~ PH NE
~ ~ / ' (act'
3. CONTRACTORZI.- IYY~QL-t/~ / ~~LA~R~7 ~~ ~1 ~x ~` ONE
l0 C.~ I lJ J' l~0 ~C~ti7' c~ ~VE~~
f ~
USE OF BUILDING
4.
5. Class of Work: NEy~ ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: l~~ ~ ~ ~ ~ U ~~~ ~ l-
7. Sq. Footage of Structure pRCludiRg Basamam and Garage):
$. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^
10. Floodplain: Fringe Yes^ No ^ Dev.Permit
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 _
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ ~~ ~ 9~
Inspections Required and Fees
.Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building ~ ~ ~ qu~~ ~Vo ~~
-~cc .~ t~ e~./
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 Inspectorand 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
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is no) completed w'lyjin 2 yeprs of dpte of i~s~ue.
SIGNATUREDF OWNER~CONTRAC~H OR AUTHORIZED AQENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Footings Drywall -
(before finish)
Framing
Final
Electrical
Rough-in
Fixtures
Final Permanent Service
Temporary Service
Mechanical ~~
Rough-in ABC
Final ~ - ~~
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved ~ o
~OL1Nf]S PRTC -Rlxlr. NF RBV. 1091