BP5688BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Application Date: I - ~ - ~~ Issue Date: ~`~'f 7 Permit Fee: $ ~~
JOB ADDRESS
~~ N ~ i
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL ADDRESS p,
~ ~ ,l
/ PHONE
,3 CONTRACTOR MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: 1=-t.C-,PL/1 ~,~~
7. SC{. FOOtage Of StrUCtUfB (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodwey Yes ^ No ^
10 Floodplain: Fringe Yes^ No ^ Dev. Permit
BFE EIev.CeA.
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 _
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separat 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 notconstitute 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 aarordance with the specifications set forth
above and in accordance with the codesJordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not enced within 180 days
or i no pleted within 2 s o~ iss
S NA E OF OWNERfCONTRACTOR OR AUTHORIZED ENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Sewer
Septic
CATIO~IV
5688
Permit
Water Service
Remote
Building
Footings
Framing
Drywall
(before finish)
Final -T~~"~~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC .
Final - ~> °~~
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THI~~$ YOUR PERMIT
Comment:
Approved By:
POUNDS PRTO: Blalr, NE ~ ~~ ~ Rev. 10/91
~ %%