BP6792BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application date: i () ' ~7r ~-~ Issue Date
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CATION
Permit
~~~
Permit Fee: $ ~ ~' Q~~
JOBADDRESS
I~ c~~~-I`~ 7-e~~~nc~~
1 , LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2 OWNER ~~~~~ ,~ /' ~r-~~e~ MAILADDRESS ZIP
~V ~ PHONE
CONTRACTOR ~ ,/~ MAILADDRESS PH~,NE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~u {fir ~~` ~,~ ~~~
7. Sq. Footage of Structure (IndBding easement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10 Floodplain: Floodwey 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 _
Building
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
NOTICE Framing Final
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the
Electrical
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 receivedacopyofthisapplicationtormsignedbytheBuildinglnspectorandstamped Rough-in Permanent Service
~APPROVED~.
Iherebyagreetoperformtheproposedworkinaccordancewiththespecificationssetforth Final Tem ore Service
p ry
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 1 SO days,
is not completed iihin 2 y f the date of issuance, o`r if work is abandoned for six (6) Mechanical
e or I g r whic eve 's ea 'e'~~.
~ f Rou h-In
9
ABC
SIGN URE NER~CONTR OR OR AUTHORIZED AGENT DATE 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: Approved By: ~ . _~ ~
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities j ~-~ g- `~S~
Sewer Tap Water Tap - L ~-
Sewer Water Service ~d - UG ~-'
Septic Remote
POUNDS PRTO: BIaV, NE ~ Rev. 08195
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nn~nr, .... ~_.___ ... - - - ~_-
°, Q ROUGH IN '~ [] FIXTURES
- ^ FINAL []MOTORS -
I
~;;• OPERMANENTSERVICE DTEMPORARYSERVICE
' MECHANICAL:
F i
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~ ~, i.
,
Q ROUGH IN ^ A/C ^ FINAL _ i
,;_~ PLUNIIiING•• j
_ . i
t ;, ^ GROUNDWORK Q ROUGH IN ~ ^ FINAL
~~, .~,~RESULTS OF TH
E INSPECTION ` ~
.... ~ •
ASSED ~sre;rro~res~ 0 FAILED ~sEErioTESI_~ ~ ~ -
"'`NOTES/REMAkKC:
f
INSPECTOR• ~q„~
O°~ f
j
-DATE OF 1NSPECTION IvIADE:- f ~ -/,~ .~ 9~ TIME: ~ ~~d /~~ j
CALLEp OPPD\
TO CONNECTSERVICE: Q y~ Qj~rO ~~
I
~• , V~ANT OFFICE STAFF TO CALL OP PD\
~
[] YES
_
-
~ NO BLR 1. j
~~