BP5986: ~ BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 ~ ~ ~
(402) 426-4191 Permit
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Application Date: ~! ~ Issue Date: ~~ " ~ ~ Permit Fee: $
JOB ADDRESS ~ ^'7~
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1 ' DESCL LOT NO. /~~
L// BLK. TRACT ~ ~ / ~• _ /
UX ^
SEE ATTACHED SHEET
2. OW ER M S ~ /~ ~ ~ ~ HOME- ~/
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3. CONTRACT MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: /~
]. Sq. Footage Of SfrUC1Ure (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ ~ ~
Floodwey Yes ^
10. Floodplain: Fringe Yes^ No ^
No ^ Dev. Permit
BFE EIev.Cen.
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 _
Site Plan Attached ^ Complete I s Atta hed ^
Approximate Completion Date ~~.~0~9c`
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote -
Building
ACCEPTED RY 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 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 commenced within 180 days
or is not cgr~l~~ed within 2 years q(~klate of issue.
SIGNATURE F~tO VNER)CONTRACT~R OR AUTHORIZED AGENT DATE
Footings Drywall
(before finish)
Framing Final `~ - ~ C ~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Ground Work
Plumbing
SIGNATURE OF OWNER (IFOWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appr ved By
a
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address ~~ ~ ~ . ~ ~ ~ Date ~ - ~ ~~ 9
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? Nc~
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' Pro ert Line
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_ _Center Line_of _ _ _
Indicate North
Street_ _
Applicant