BP6730`r
BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit 6730
Application Date: 4 q 5 Issue Date: q -2—> - 1-1 S Permit Fee: $ 5
JOB ADDRESS 13/—[/ `
C�
Mechanical
LEGAL LOT NO.
1.
A\C
BLK.
TRACT
❑ SEE ATTACHED SHEET U ——
DESCR.
Ground Work
Rough -in
Final
i
2.OWNE
MAILADDRESS ZIP /
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PHONE
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MAILADDRES ONE
+LIC
NS 0.
4. USE OF BUILDING
5. Class of Work: ❑ NEW
❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE
❑ REMOVE
6. Describe Work:-}
7. Sq. Footage of Stru re (Including Basement and Garage):
8. Change of Use From:
Change of Use To:
L
9, 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 ❑ Nog
14. Variance Required: Yes ❑ No Er
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ❑ No [Waiver Approved _
APPLICATION ACCEPTED BY I PLANS CHECKED BY
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 codeslordinances 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 i� complete within 2 years of date of issue.
y r 1,1,1f
SIGNATURE OF OWNER/CONTRA OR AUTHORIZED AGEYT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ❑ Complete PI ns A ched ❑
Approximate Completion Date Z
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building 3, ��lo . der f'g tr1
Footings Drywall DU 1! e (*�e 12% �b e�
(before finish)
Framing Final 3`
Electrical
Rough -in Fixtures
Final Permanent Service
Tem ora Service I
P ry
Mechanical
Rough -in
A\C
Final
Plumbing
Ground Work
Rough -in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blelr. NE Rev. 10191
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