BP6084t ~ BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
~- ~2"cl ~ Issue Date:
Permit 6 0 S 4
Permit Fee: $
JOBADDRESS
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ ' MAILADDRESS ZIP PHONE
CONTRACTOR
3. ~~ ~5 MAILADDRESS PHONE LICENSE NO.
C_Y'~ ~l ~~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR VE OVE
6. Describe Work: (~ ` ,/ lJ
7. Sq. FOOtage of StrUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Flooaway Yes ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
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
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 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 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 OWNERiCONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap
S Water Tap
t
S
i
~~ /
W
ewer a
er
erv
ce
Septic Remote
Building
Footings Drywall
(before finish) ~
~/
Framing j
Final 1 ~ ~ ~ r
Electrical
Rough-in Fixtures
Final Permanent Service
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 IS YOUR PERMIT
Comment: Approved By:
CATION
POUNDS PRTG: Blelr, NE Rev. 70181
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