BP6186.- BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 618 6
(402) 426-4191 Permit
Application Date: > > 7
Issue Date:_
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Permit Fee: $
JOB ADDRESS
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1
LEGAL LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
,
DESCR.
2. OWNE ~ ~ MAILADDRESS Zlp PHONE
3. CONT C - / , MAILApQ~ESS PHONE ~ LIC SE -~ ~ -
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USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
~ ,c
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^
10
Floodplain: Dev. Permit
Elev
cerr
.
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 _
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 copy of this application form signed by the Building Inspector and stamped
'APPROVED'.
I herebyagree 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 th t this permit is void if work is not commenced within 180 days
or is not eomp~eted w' ~' 2 years of date of issue.
IG TURE OF = NE (CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Comple~ PI~~ ~Atta~t1' ed
Approximate Completion Date ~ ,
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings
Framing
Drywall
(before finish) ~
Final ~ ~~6 ~l_~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC _
Final .~
Plumbing
Ground Work
Rough-in Final ,
WHEN PROPERLY VALIDATED (IN THIS SPAS THIS IS YOUR PERMIT
~7~1
Rev. 1091
POUNDS PRIG: Blelr, NE
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GROUNDWORK ^ ROUGH-IN . ^ FINAL
RESULTS OF THE INSPECTION;: ^PASSED~s~ErrgTES~ ~EAILED(s~NOTES>
NOTES]REMARKS: -
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