BP5760BUILDING PERMIT APPLICATION ~~
Jurisdiction of City of Blair, Nebraska
218' South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
5760
Application Date: ~ ~ ~T" ~y Issue Date: ~ e ~ S cl ~~ Permit Fee: $ ~ ~
JOB ADDRESS / •~~ ~^/ ~ ~rZ , //
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LEGAL
1 ' DESCR. LOT NO. B
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K. TRACT
^ SEE ATTACHE
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SHEET
2 OWNER ~~~' "r \ / '~ 0 / / MAILADDRESS ZIP
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3, CONTRACTOR ~~~
/ U LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~_~ _ ~ ~~~~ ~~ ~~
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ Z r OCR
10. FIOOdplaln: Floodway Yes^ No ^ Dev. Permit Elev. Cert.
Fringe Yes^ No ^ BFE
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
ACCEPTED 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 acopyof 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 thecodes/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 s n completed within 2 y rs of date of issue.
OF OWNER~CONTR!lICTOR OR AUTHORISED AGENT DATE
Site Plan Attached Complete Plans Attached ^
Approximate Co eti n 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 Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv' B : ~//„
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