House DescriptionJOB ADDRESS:
SUBDIVISION:
WASHINGTON COUNTY BUILDING PERMIT APPLICATION
1555 Colfax Street, Blair, NE 68008
Office. (402) 426-6872 Fax; (402) 426-6843
lanning )%vashingtoncountvne.or
then use "0" w/th lot # and street name until address is assignea/
LOT:
c) ,
HOMEOWNER:
CURRENT ADDRESS: CITY'
STATE: ZIP:
PHONE NUMBER: % EMAIL:
*HOMEOWNER INFORMATION IS RE IREb"
GENERAL CONTRACTOR:
ADDRESS:
PHONE:
FAX.
CON RACTOR
CITY. STATE: ZIP:
CELL:
EMAIL:
FILL OUT ONLY WHAT PERTAINS TO YOUR PROJECT*
NEW RESIDENCE.; ADDITION
FRONT PROPERTY LINE OR
CENTER LINE OF COUNTY ROAD:
FLOORS: BEDROOMS:
22
1st FLOOR: ,
FINISHED BASEMENT:
ACCESSORY/ SUNROOM SOLAR
REMODEL POLE BARN DECK/PATIO/PORCH(S) POOL GRAIN BIN PANELS
(Includes any Lean-tos)
REAR: SIDE: SIDE:
(Number of each)
GARAGE FLOOR
DISPOSAL:/ z. OVERSIZE TUB(>50 GALS): GARAGE BAYS: DRAINS:
If addlNon/Remade!pro%tt provide only sq. ft. on Addition/Remodel, not whole house
2nd FLOOR: 3rd FLOOR: GARAGE: /121-`
UNFINISHED BASEMENT: DECK/PATIO/PORCH(5) (Total of all):
NISHEDACCESSORY ............................... -___I DETACHED GARAGE:
MEZZANINE:--_^V---_--_-y MEZZANINE:
POOLS: GRAIN BIN DIAMETER:
ACCESSORY FLOOR DRAIN:
(Project only):
NUMBER:
DETACHED GARAGE FLOOR DRAIN:
POOL: I GRAIN BIN:
SOLAR PANELS
SIZE:
SOLAR PANELS:
ESTIMATED START DATE:.„=! ESTIMATED FINISHED DATE:
The above requested information is, to the best of my knowledge, true and accurate. it is understood and agreed that any error, misstatement or
misrepresentation of fact, either with or without intention on my part can cause a refusal of this application or any alteration or change in plans
made without the approval of the Washington County Building Inspector subsequent to the issuance of the building permit shall constitute
sufficient grounds for the revocation of such permits.
By this signature, the Washington County Bull in Inspector or authorized representative of Washington County is authorized to enter upon the
property described f urose,of inspec to
DATE:
SIGNED
(Note: we will not accept the application, if all required documents are not provided at the time of submittal) 8/2018