BP7446BUILDING PERMIT APPLICATION
~~ ~~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
(402) 426-4191 • Fax (402) 426-4195 Permit-
Deposit Receipt #:
Application Date: ~~/~/g~ Issue Date: ~ r ~~~~
JOB ADDRESS .~ ~ `
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LEGAL
1. DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~ AIL ADDRESS ZIP ~ON~ ~~
~.
RACTOR
3. - MAIL ADDR SS ~~ /~
Ol`1A ZIP `_'PHONE
G-._.i~-~
4. Class of Work: O EW O ADDITION O REMODEL
5. Describe Work: ~ .,_._ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRDIudiRg Basement and Garage>: Total Finished Area:
~, u
7. Valuation of Work: $ ~~~~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes O Nc
O No
O No
Side Rear
Waiver Approved
NOTICE
Separate permits are required for electrical, plumbing, healing, ventilating and air
conditioning, 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
Inspector.
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 o is not com eted within 2 years of date of issue.
~~~~ ~~
51GNATURE OF OWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached O
Co~y~te Plans Attached
l~
Approximate Completion Date ~
~
~~
Inspection s Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
Framing ~I
Final ~ ~ ~ ~ ~ /
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin _
Ground Work
Rough-in _
Final
WHEN PH6~ERL VALIDAT (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By;
7446
POUNDS PRTG: elair, NE Rev. 6/96
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