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BP7050~,/ BUILDING PERMIT APPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit j ~ J Application Date: ~~ ! L{-~"I ~o Issue Date: ~ ~~- ~ ~r Permit Fee: $ ~ QtJ JOB ADDRESS ~ ~ ~ r b ~ LEGAL 1 LOT NO. BLK. TRAC ^ SEE ATTACHED SHEET . DESCR. 3 ~ 1 ` Z.~ MAILADDRESS ~ ~ ~ ZIP P2H ONE ~ ~ l e U ~ ' ,3.~N~AC \R ` MAILADDjESS ~~~ ~ ~ PHONE ((~J r' ~ LICENSE NO. ~ ~ r DQ YYY rQ~ Z ll Z~ 'C USE OF BUILDING 4. 5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: t S VLC ~'~ .~G~(` U°e ], Sq. FOOtage of StrUCtUre (Including Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ - ~ ~ ~ ©~ 10. Floodplain: Floodway Yes^ No ^ Frin e Y ^ N ^ Dev. Permit Elev. Cert. g es o 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 _ Site Plan Attached ^ Complete Plans Attached ^ Approximate Completion Date ~~~ '~ Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY NOTICE Separate permits are required for electrical, plumbing, heating, ventilaiing 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 bythe 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 u derstand that this permit is void if work is not commenced within 180 days, is not com~ed within 2 years gf the date of issuance, or if work is~bandoned for six (6) mo onger, w ichev r' e eSR. ~ 9 SIG ATURE OF OWNEFl~ NTRACTOR OR AUTHORIZED AGENT DATE C~4T1 O N Building Footings Drywall (before finish) Framing Final ~ ~g ~S~ Electrical Rough-in Permanent Service Final Temporary Service Mechanical Rough-in ABC _ Final Plumbing Ground Work SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: ull IlJIIC GRTR _Rle~r NF R0V.08~9 ~' ~~. ~y]/~ /' r - O ~ ; f`. DATE OF INSPECTION MADE: N.~ d ""TYNE: ~° _ -~ ~~ .'1 t~ ~: - • CALLED OPPD\ TO CONNECT SERVICE:. ,_ ^ YES ^ NO . ~a ~= ` WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR t ~ - _ - __~.