BP6179BUILDING PERMIT APPLICATION ~ io~~ I
Jurisdiction of City of Blair, Nebraska RP~~ ~(L. ~ t/Zlo3~-
218South 16th Street 617 9
Blair, Nebraska 68008
(402) 426-4191 Permit
_ _G
Application Date: II ~ ~~ Issue Date: ~ I " I ~ ~~~ Permit Fee: $ ~ ~
JOB ADDRESS
~ ~~
,-o r ~
LEGAL
1 • LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
DESCR.
OWNE~
2 MAIL-~A9DRE~S _ ~ -
ZIP PHONE
. f~ ~
C
3. CONTRACTOR /'~
1 MAILADDRESS P E LICENSE NO.
~
6
USE OF BUILDING
4.
5. Class of Work: ^ NEW ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ,~ -- "~
7. Sq. Footage of Struct a (Including Basem t and Garage): ~ ~ ~ /~ ~ /
$. Change of Use From: Change of Use To:
g, Valuation of Work: $ a ~ ~°°
10. Floodplain: FI°oaway 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 ~
Site Plan Attache ~ Complet PI ns Attached:.
Approximate Completion Date '~ 1 Rte- J
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ~~
15. Minimum Setbacks: Front Z~~.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 farm signed bythe Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
ov d ' accordance with t e codesJordinances of the City of Blair and the State of
rask nderstand tha ermit is void if work is not commenced ithin 80 days
or is co leted within a of date of issue. ~~ !~
IGNA R F OWN fCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Sewer
Water Service
Septic Remote
Building
Footings ~~-23"~`~ Drywall
(before fineish)/ //~' w /`'~
r V V~(/ r L~
Framing ~ (~ Final ~`
Electrical
Rough-in ~^-~ ~ ~ Fixtures
Final ~ ~U>~-~ 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 y:
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
6232
Permit
Application Date: ~ Z °/ ~"C~ `~ Issue Date: / 2" Z ~ ~1 ~ Permit Fee: $ (~ ~~~
JOB ADDRESS ~ ~ ~ ~J rl~~_)~ I n `
1 . LEGAL
DESCR. LOT NO. BLK. RACT ^ SEE ATTACHED SHEET
OWNER ,n I (I~ MAILADDRESS ZIP PHONE
2. fu..e~/
3. CONTRACTOR MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~i~~j'1'~ ~ .~; ~~
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^ Dev. Permit
10. Floodplain: Elev. ced.
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 _
TION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separat 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 copy of this application form signed by the Building Inspector and stamped
'APPROVED'.
I h@ agreetoperformtheproposedworkinaccordancewiththespecificationssetforth
ab~ ean in cordance with the wdesJordinances of the City of Blair and the State of
Nebra~ a. I n erstand that this per it is void if work is not commenced within 180 days
or is of m ted within 2 ears ate of issue.
SI ATUR OF WNER ONTRACTOR 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 • ~y' Fixtures
Final ~' •Q~-' 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 I O'1.1R PERMIT
Comment: Approved By: J~f ,, ,/
POUNDS PRTG: Blelr, NE /f \. Rev. 10/91
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