BP5950BUILDING PERMITAiPPLI
Jurisdiction. of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit 5 9 5 0
Application Date: (~ '~~ ~ ~ ~ Issue Date: ~~3U_ ~ ~ Permit Fee: $ ~~
JOB ADDRESS / I ~ S ~ ~ S~ ~~ '
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LEGAL
1' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2. OWNER ~~ ~ MAILADDRESS ZIP PHONE
3. CONTRACTOR MAILADDRESS HONE
J.,1 ~ ~ ~ ~6X 2 lG~ f f~" LICENSE NO.
~~~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ ~~~
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ 2 ~ I
Floodway Yes ^ No ^
10. FIOOdplaln: Fringe Yes^ No ^ Dev. Permit
BFE EIev.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
APP A~CE~Y 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 Inspectorand 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
orbs not completed within years of date of issue.
.. . ,
OF OWNER~CONTRACTOR 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
i
~ (before finish) ppf~
Fi
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Fram
ng na
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
CATIO_iV
Comment: Appr v;~d °
OUNDS PRTG: Bleb. NE Rav. 10f9
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