BP6135
BUILDING PERMIT APPLICATION
- Jurisdiction of City of Blair, Nebraska
218 South 16th Street 613 5
Blair, Nebraska 68008
(402) 426-4191 Permit
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Application Date: ~O ~ ~ ~ - R `~ Issue Date: ~ ~ , j ~. ~~ Permit Fee: $ ~' D O
JOB ADDRESS
3 ~ ~ ~ ~ rr~ J9~ .
1 ' LOT NO. /~ BLK.
S TRACT ^ SEE ATTACHED SHEET
DESCR, /~
2, OWNER MAILADDRESS ;r~r ^~ ~r r ZIP PHONE
`Y ~l/ I I
PHONE LICENSE NO.
CONTRA 0 MAIL ADDRESS
3
,
USE OF BUILDI
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~
], Sq.FOOtageOfStrUCtUre(IncludingBasemenlandGarage): ` ~',
9
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ 9' j ~D . D ~
Floodway Yes^ No ^ Dev.Permit
EIev
Cert
10
Floodplain:
.
.
.
FrlRge 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 ~~ide _ ~ Rear~!~
16. Sidewalk Required: Yes ^ No [~]-dV"aiver Approved
APPLICATION ACCEPTED 8Y 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 Inspector and stamped
'APPROVED'.
I herebyagree 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 mpleted within 2 years ~ ate of issue.
SIGNATURE OF OW JC NTRACTOR OR AUTHORIZED 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 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 `y:
OUNDS PRTG: Blelr, NE Rev. 10(r
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
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Address /.3~ ~ ,~'~<~=~.~s-
Legal Description: Lot /3 Block //.5 Addition °~~-.~~~~aE~",~~``
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot? ~~~_
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