BP6337- ,~
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~~~ /~GZ7Z5Z b ~~ ~15~5~
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: _ ~ ~~~ - ~ S Issue Date:
6337
Permit
Permit Fee: $ ~ d O.O~
JOB ADDRESS
S s . ~3~-h
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAILADDRESS vp PHONE
2. cis y,~veS .
3. CONTRACTOR MAILADDRE ,~ PHONE UCENSENO.
~- e~\ ~{,~,res /v ll use /3 y7 vi/ hr'1 n v -9 ~'
4. USE OF BUILDING I
yuQ~gY~ ~ - ~~hr~
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: {~iemC~~~ (•(~ (~ (•~~ r
7. Sq. Footage of Structure (Induding Bin, and Garega):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ jp~ ~ b00 • U
10 Floodplain: Floodwey Yea^ No Q Dev.Permil
Fringe Yes^ No ^ BFE Elev. Cert.
> > . current ~onfng:
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
APPL~ATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE 8Y
' NOTICE
Separate permits are required for elecVical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the
building permit application fee does not constftute 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 hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codeslordinances of the City of Blair and the State of
Nebraska. I understand at this permit is void if work is not commenced within 180 days
or is of ed n t of issue.
_g
ATURE OF OWNERiCQNTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Com lete_Plans Attached
Approximate Completion Date ~" lS ~ 7 S
Inspections Required and Fees
Sewer Ta Utilities
p Water Tap
Sewer ~ ~~ ~' Water Service
Septic Remote
S}q ie t Ife .~ArSh~l,l CG~~ - ~~_Z ~ _~ ~~
Building
Footings Drywall
(before finish)5' ~ ~_9~
Framing ~~~~~~ Fnal ~~~~"~~
~~ 5 Electrical
Rough-in Fixtures
Final Permanent Service ~'l~~(.~
Temporary Se
Mechanical
Rough-in ABC _
Fnal
I Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in ~
;~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
Rav. t0~D1
~`~ ,BUILDING PERMITAPPLI
~~ ~~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
5405
~o
Application Date: ~ ~~ ~ Issue Date: ~~ ~~ ^ Permit Fee: $ ~~
JOB ADDRESS
~~
~ ! J
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNE ~ MAI ADDRESS Zlp PHONE
r3 CONTRACT R MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~, ~
]. Sq. FOOtage Of StrUCtUre (IRGuding Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^
10: Floodplain: Fringe Yes^ No ^ Dev.Permit
No ^ 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 _
PLICAT~ CCEPTED BY 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 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
or is not compl within 2 ye s of date of issue.
c'Y,-, 2~- ~7
SIGNATURE 0 ERfCONT CTOR 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 Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
~°
~ Electrical
Rough-in Fixtures
Final O'
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: Approv B : _
POUNDS PRTG: Bleb, NE Rev. 10191
' ~ :
n~
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 410
(402) 426-41 1 Permit
_ S ~
A lication Date: ~ ~ Issue Date: ~ ~ ~~ Permit Fee: $ ~0
PP
i
JOB ADDRESS
g ~
C~~~//
~/~.
LEGAL
1' DESCR. LOT N0. BLK. TRACT
^ SEEATTACHEDSHEET
2.OWNE IL ESS ZIP
~~ PHONE
3 CONTRAC /. MAILADDRESS PHONE - LIC . N .
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: $
10. Floodplain: FlDOaway Yes ^ No ^
Fringe Yes^ No ^ Dav. Permit Elev. Cert.
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 _
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
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 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
o ' co leted within 2 vearsef'tiate of issue.
--
OF OWNER/CONY ACTOR OR AUTHORIZED AGENT DATE
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work pG
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in /~ ° ~ Final
WHEN PROPERLY VALIDATED (IN THIS SPAS',.E) THIS IS YOUR PERMIT
POUNDS PRTG: Blelr, NE Rev. 70/81
- ~ BUILDING PERMIT APPLICATION
J '' ~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 4 5 5
(402) 426-4191 Permit
5 q >~
Application Date: / ~~ Issue Date: `~ ~~ Permit Fee: $ ~S~i
JOB ADDRESS
~~ / ~
~ C
LEGAL
1 LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
2, OWNER M LADDRESS - = ZIP PHONE
S
,3, CONTRA R ~ ~ MAILADDRESS~ PHONE LICENSE NO.
M..~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StrUCture (InGuding Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Flaodway 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 ^
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 bythe Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codesJordinances of the City of Blair and the State of
Nebras nderstand that this pelt is void if work is not commenced within 180 days
oyi not co pleted within try s of to of issue.
OF OWNERICONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
e
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 SPACF~THLS IS YOUR PERMIT
Comment: Approved By: ~ ~ 1
POUNDS PRTG: Blab, NE Rev. 10r81
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