BP5796BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
5796
~~`~
Application Date: ~' ~~ Issue Date: y"~Z'~y" Permit Fee: $ ~Li
JOB ADDRESS
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
MAIL ADDRESS ZIP PHONE
CONTRA OR / Mg16~DDRESS PH ~ E ~ ~~ IC SE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage of StrUCfure (Including Basement and Garag .
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~> ~~~ o~
11). FIOOdplaln: Floodway Yes ^
fringe Yes^ No ^ Dev. Permit
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 _
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 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 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 180 days
or is not mpleted within 2 years of date of issue.
SIGNATU OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete. PI ns A he • ^
Approximate Completion Date ~~,~~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~n`~°Z~ ~~
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
Final -
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Electrical
Mechanical
- ABC
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