BP6276BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Application Date: I - Z ~- ~ S Issue Date: ~ " ~ ~ ~~ Permit Fee: $ T~}' ~ ~ ,
JOB ADDRESS
I ~c ~~ l
~~~~~
~~r~ e,
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER;
2. ~~C ~ r ,MAI ADDRESS ZIP PHONE
~-(.~
3. TRACTOR
,~ MAILADDRES PHONE LICENSE NO.
USE OF BUILDI
4. '
5. Class of Work: ^ NEy1/ ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~ ~ ~~ ~ c
~,u ~ , C C'
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~~ ~~~~~ ~CjC~ ~~) • (~~
10. Floodplain: FI°Daway Yes ^
Fringe Yes^ No ~~
No I~J Dev. Permit Elev. Cert.
BFE
11. Current Zoning: ~~
12. State Fire Marshall Required: Yes ~I No^
13. Special Use Permit Required: Yes ^ No~
14. Variance Required: Yes ^ No
15. Minimum Setbacks: Front ~de /Rear ~
16. Sidewalk Required: Yes^ No ^ Waiver Approved
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 copy of 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 a in accordance with t codes~ordinances of the City of Blair and the State of
Nye ?a I understand I ermit is void if work is not commenced within 180 days
is t mpleted with s of date of issue.
- -
OF 6WNECi1CONTRACTOR ORAUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Sewer
6276
Permit
Water Service
Septic Remote
Building
Footings Drywall ~
(before finish) ~ ~-
Framing `~~ ~l-~~~~ Final ~~ - ~~ ~~
n -2F~ Electrical
Rough-in ~~ S Fixtures
Final / Permanent Service ~ 2 -~~-.
Temporary Service
/~echanical
Rough-in • j" ABC
Final
Plumbing
Ground Work ~
Rough-in Final ~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
R<~c,~d ~/vr o~~
CATION
Comment: Appr ed
SOUNDS PRTG -Rlelr. NE Rev. 109
J-
„/~~ ~'L"
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 2 9 9
(402) 426-4191 ' Permit
Application Date: `~ Issue Date: ~ ~ Permit Fee: $
JOB ADDRESS ,. %
~/`/
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNE MAILADDRESS ZIP PHONE
3. CONT TO ~ RESS PHON LICENSE NO.
c.~J
'/~(~-
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR MOVE ^ REMOVE
6. Describe Work: /L~
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°oaway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
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 Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
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 OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish)
Framing Final
~ ~ Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
/~ UG Mechanical
Rough-in [~ ABC
Final ~
Plumbing
Ground Work ~ G O
Rough-in /~ Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved B
POUNDS PRTG: Blelr, NE Rev. 10/91
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