BP7782BUILDINCa PERMIT APPLICI~-TION
~ ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 Permit 7 7 ~ 2
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4/195
~ Issue Date: ~/~ / ~~
Application Date: ~~ ~~~
J08 ADDRESS ~~ ~ /~ ~~~
LEGAL LOT NO. BLK. TRACT
1 DESCR
OWNER / MAIL ADDRESS
2 ~ ~ /~-/~
3 CO~A~OF(._ _ (y~~~(L ' - ~~ ~/,L ADDRESS ~ `u
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work:
~ --
^ SEE ATTACHED SHEET
ZIP PHONE
ZIP
O Finished Basement O Unfinished Basement
6. TOtal Sq. FOOtage (Including Basement and Garage): TOtal FInlShed rea:
7. Valuation of Work: $ ~`~~
Floodway O Yes O No Dev. Permit Elev. Cert.
8. FIOOdplain: Fringe O Yes O No BFE
O Site Plan Attached O Complete Plans Attached
9. Current Zoning: Approximate Completion Date /
~-( ~=~~
10. State Fire Marshall Required: O Yes O No Inspections Required and Fees
11. Special Use Permit Required: O Yes O No Utilities
12. Variance Required: O Yes O No
Sewer
Water Service
Septic Remote
13. Minimum Setbacks: Front Side Rear
Stop Box Card
14. Sidewalk Required: O Yes O No Waiver Approved
Buildin
NOTICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air
I acknowledge that payment
nature below
i
B (beforetinish)
7 - ~ - ~'~
,
g
y mys
conditioning, and septicsystems.
ildi Final
ng
of the building permit application fee does not constitute issuance of this bu Framing
permit. I further agree that construction covered by this permit application shall not be
commenced until I have received a copyof this application form signed bythe Building Electrical
Inspector.
I hereby agree to perform the proposed work in accordance with the specifications set
Rough-in
Fixtures
forth above and in accordance with the codes/ordinances of the City of Blair and the
State of Nebraska.lunderstandthatthispermitisvoidifworkisnotcommencedwithin Final Permanent Service
180 days or is not completed within 2 years of date of issue. Temporary Service
Mechanical
SIGNATURE OF OW CONT OR DATE
Rough-in
A\C
Final
Plumbin _
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
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