BP5584BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
5584
l 0 "
Application Date: L Issue Date: () _ / � Permit Fee: $
JOB ADDRESS -�-) -9 q �- �6�_
Site Plan Attached ❑ Complete PI ns A hed ❑
Approximate Completion Date / -3l �
LEGAL
1 ' DESCR.
LOT NO.
BLK.
TRACT
SEE ATTACHED SHEET
2. Mnryn ) C MAILADDRESS f ZIP
V l
533IZW - HONE
J
3. CONTR R MAILADDRESS PHONE
LICENSE NO.
4. USE OF BUILDING
Water Tap
5. Class of Work: ❑ NEW ❑ ADdTION ❑ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
6. Describe Work:
%. Sq. Footage of Structure (Including Basement and Garage):
Water Service
8. Change of Use From: Change of Use To:
Septic
9, Valuation of Work: $
Sidewalk Required: Yes ❑No Waiver Approved
10 Floodplain: Floodway Yes ❑ No L'— Dev. Permit
Fringe Yes❑ No 0� BFE
Elev. Cert.
11. Current Zoning:
Site Plan Attached ❑ Complete PI ns A hed ❑
Approximate Completion Date / -3l �
12. State Fire Marshall Required: Yes El No[?
Inspections Required and Fees
13. Special Use Permit Required: Yes ❑ No
utilities
Sewer Tap
Water Tap
14. Variance Required: Yes[:] No❑
Sewer
Water Service
15. Minimum Setbacks: Front Side Rear
Septic
Remote
Sidewalk Required: Yes ❑No Waiver Approved
(Z16.
Building
H _ / Z q 4--
Footings
Drywall 6-1116 j
T N ACCEPTED BY
PLANS CHECKED BY
APPROVED FOR ISSUANCE BY
(before finish)
Framing
Final A-�-5
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
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
Rough -in
Fixtures
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
Final
Permanent Service
above and in accordance with the oodes/ordinances of the City of Blair and the State of
Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 180 days
oris not tete within 2 y rs of date of iss
�r1211 '
Mechanical
Rough -in
Final
AIC
SIGNATURE OF OWNERfCON RACTOR OR AUTHORIZED NT DATE
Plumbing
Ground Work
Rough -in
Final
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d$y
SOUNDS PRTG: Blair. NE Rev. 10/9
CITY OF BLAIR
Application for Building Permit
DT nm nr.nrl
Address 1� 9 / X � ? 7, A-) a— Date O ZZ2 4
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? C�
Indicat�North
Center Line of 7X
Street
Applicant