BP6520Application Date:
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
Issue Date: C'" IH—
Permit Fee: $
6520
JOB ADDRESS 7_54� ll�J /.=-5(
Inspections Required and Fees
LEGAL
1 ' DESCR.
DESCR.1
LOT NO.
BLK•
Sewer
TRACT
❑SEE ATTACHED SHEET
2. OWNER
ADDRESS ZIP
PHONE
3. COT CTR MAILADDRE /PPNE
LICENSENO.
Cj(//,",
4. USE OF BUILDING
(before finish)
Framing
5. Class of Work: ❑ NEW ❑ ADDITION
❑ALTERATION ❑ REPAIR
❑ MOVE ® REMOVE
6. Describe Work: r
i
Final
7. Sq. Footage of Structure (Including Basement and Garage):
Temporary Service
8. Change of Use From:
Change of Use To:
Rough -in
9, Valuation of Work: $ , SISb Q , o
Final
10. Floodplain: Floodway Yes ❑ No [3Dev.
Fringe Yes ❑ No 11BFE
Permit
EIev.Cert.
Ground Work
11. Current Zoning:
12. State Fire Marshall Required: Yes ❑ Non
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 _
ACCEPTEp BY 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 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 comnle3ed within,2rmmof date Df issue.
OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ❑ Complepirstt�che�
Approximate Completion Date Y�
Inspections Required and Fees
Utilities
Sewer Tap
Water Tap
Sewer
Water Service
Septic
Remote
Building
Footings
Drywall
(before finish)
Framing
Final
Electrical
Rough -in
Fixtures
Final
Permanent Service
Temporary Service
Mechanical
Rough -in
A\C
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough -in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved
o—
OUNDS PRTG: Blair, NE Rev. 109
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