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BP6948~IJIL~lC~ P I~~~LICATI®N Jurisdiction of City of Blair, Nebraska 218 South 16th Street Application Date: Blair, Nebraska 68008 6 ~ Ljl (402) 426-4191 Permit #a4~~ ^ ~ ~ ^~ ~' Issue Date: Permit Fee: $ 1,~© ~' JOB ADDRESS/~ / / LEGAL 1 ' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHEDSHEET 2 OWNERn/, ~ MAILADD~~~ ~ /// ~ ~ ZIP (~L' f ,C~Gyc.p~ PHONE o~-~~.5 3 CONTRA OR MAILADDRESS PHONE LICENSE NO. USE OF BUILDIN ~ ~~Q '• ~~ 4. -GEiC 5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION [REPAIR ^ MOVE ^ REMOVE 6. Describe Work: c' ,~ 7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): 8. Change of Use From: Change of Use To: g, Valuation of Work: $ ~~ L~ ~ d'© 10. Floodplaln: 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 APPLICATION ACCEPTED BY I PLANS CHECKED BY ( 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 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 Inspectorand 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 (6) month r I nger, wh' hever is rifest. x ~~ ~~-~~~ ~~ ~~~~-9~ SIGNATURE OF OWNERICONTRACTOR 0 UTHORIZED AGENT DATE Site Plan Attached ^ Complete Plans Attached ^ Approximate Completion Date ~''-l- ~~ Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote Building Footings Framing Drywall (before finish) Final Electrical Rough-in Permanent Service Final Temporary Service Mechanical Rough-in ABC _ 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: Appr ve - , C-~ ..cam POUNDS PRTG: Blair, NE ~' OBlB5 ii 1; j r/ i' i