BP6431BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 4 31
(402) 426-4191 Permit
Application Date: ~/ - Z' / S Issue Date:
~1- 2~7-~C~"
Permit Fee: $ 1~G0
JOB ADDRESS
Z z ~ ~ ._~m,~~+~~,
1
LEGAL LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
.
DESCR.
2. OWNER ~~/~ ~ ~/ Q ~n~ MAILADDRESS ZIP PHONE
/ J /
n O Ill) ~ RESS / ~ ~~~(~ PHONE ~~/ ~ ~~ ~ ~ LICENSE NO.
3. CONTRACT
G r~ ~~ e ~- ~/4 L/,xC~(~Jc (/I/~ I ~O
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~ ~~~
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ C~~ C~ . (~(~
10. Floodplain: Floodway Yes ^ No Q Dev. Permit Elev. Cert.
Frin
e Y
^ N
^
g
es
o
BFE
11. Current Zoning: ~~ ~
12. State Fire Marshall Required: Yes ^ NoO~'
13. Special Use Permit Required:- Yes ^ No [~'
14. Variance Required: Yes ^ No [~
15. Minimum Setbacks: Front Side ,~_ Rear ~
16. Sidewalk Required: Yes^ No ^ Wa u r 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 by the 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 i~.not- pleted within 2 years of date of issue.
~/~~1~~~
SIGNATURE OF OW ER/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
(before finish)
Framing _
Final ~~~ ~~ ~~/~S
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
Comment: Appro ed-By:
i
OUNDS PRTG: BIeIr. NE Rev. 10r8
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address ~~-~? Sc? ~~~ _ Date ~"o~ 1 ~ ~S
Legal Description: Lot Block Addition
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc,, and property lines.
Is this a corner lot? /+~'O
J ~~
'' Pro ert Line
a ~~
f "mil
~Q
r
~,°~ a
~~ ~~ r
-- -- -
i a~~ ~°~~
v -~ o.
~ ar~-
v
0
~ ~ s
"~° 1.
.~
,,
Indicate orth
0
Center Line of Street_ _
Applicant ~,~~f ~, ~~~~,~,~
%~
~~
lnrcucr~~rnn. 'll