BP6599BUILDING PERMIT APPLICATION ~~~~~
Jurlsdfctlon of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 5 9 9
(402) 426-4191 Permit
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Application Date: ~ ] ~ Issue Date: Permit Fee: $ ~ r'
JOB ADDRESS ~~
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LEGAL
1. DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2 OWNER ~ L1~Y MAILADDRESS ZIP PHONE
3. CO CTOR
~,or n Id~r,~ MAILA DRES PHONE ~~ I L.~ z 3 ° 27 ~ LICENSENO.
hlI ~au~c.~;~ ~P.o. - ~ n~.c~c~ Slo~o-p~~
USE OF BUILDING
4.
5. Class of Work: EW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~..U ~ I
]. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): ~ ~( ~Q
I` U
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
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1O FIOOdplaln: Floodway Yes^ No
Fringe Yes^ No Dev.Permit
Elev. Cen.
BFE
11. Current Zoning: ~ ~
12. State Fire Marshall Required: Yes ^ Nom
13. Special Use Permit Required: Yes ^ No [~"
14. Variance Required: Yes^ Nod
15. Minimum Setbacks: Front Side ~ Rear ~'
16. Sidewalk Required: Yes^ No,~ Waiver Approved
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVEp FOR ISSUANCE BY
" v 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 completed within 2 years of date of issue.
SIGNATURE OF OWNERJCONTRACTOR OR AUTHARIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I
_ ~i C 1ci i
Site Plan Attached ^ ~r om ~ ete Plans Attac ed
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings c-2 t ~l ~~ Drywall
(before finish) 1
Framing Final ~
Electrical f ~Or~
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
F' I
Mechanical y~bncG
- ABC
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Plumbing IV D~tY~
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~" ~^
OUNDS PRTG: Blelr. NE Rev. 1001
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