BP6562t~~~;~J l~S- C~~ / .~ ~'S x.1'1 C~~ -~ ~~ ~ 1 °-~~~~'_~
~- BUILDING PERMIT APPLICATION~~ ~~
Jurisdiction of City of Blair, Nebraska ~-- ~~ ~~
218 South 16th Street
Blair, Nebraska 68008 6 5 6 2
(402) 426-4191 Permit
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Application Date: ~ "z ~ "~~ Issue Date: Permit Fee: $
JOBADDRESS ~ C~
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1 . LEGAL
DESCR. LOT NO. B~• TRACT ^ SEE ATTACHED SHEET
2. OWNER MAILADDRESS Zlp
.n (~ PHONE
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3. CONTRACTOR MAILADDRESS PHONE
s~~~ LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ ~ /~j/~~
7. Sq. Footage of Structure (Inauding Basement Bnd GBrege):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~~ ~~
10. Floodplain: Floodway 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 _
APPLI I~ ~~CEP/n^TE ~ I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY I
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 bythe 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 leted within 2 ars of date of issue.
~. ~~~
SIGNATURE OF OWNERICONTRAC70R OR AUTHORIZ AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
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
Rough-in
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:
Mechanical
- ABC _
POUNDS PRTG: BIeV, NE Rev. 10/91
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address Date
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?
a
~r
H
Y
~r
T
rQ
F
a
Center Line of Street
Indicate North
Applicant