BP7084BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
Application Date: - Issue Date: Permit Fee: $ ~~
JOB ADDRESS
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LEGAL
1 LOT NO. BLK. TRACT
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' DESCR.
2 0 NER ~ ~ ~ ~ MAIL AD
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3 C NTRA T R ~r( MAIL DDRESS ~^
~ S PHONE LICENSE N0.
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4. USE OF BUILDING
5, Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ _ c~ ,~, r ~ r ~
7. Sq. Footage of Structure (IRduaing Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ '33Q~ e Cj~
Floodway Yes^ No ^
10
Floodplain: Dev.Permit
Cert
EIev
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Fringa 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
APPLICATION ACCEPTED 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 acknowledge chat 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,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (8)
months or longer, whichever is earliest.
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)
7~ ~ ~ 7
Framing Final
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
Final
~-" Ground Work Plumbing
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SIG ATURE OF OWNER (IF OW BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
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'OUNDS PRTG: BIeIr, NE Rev. Oela!