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~ BUILDING PERMITAPPLICAI'ION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
Application Date: ~ ~ ~ ~ 5 ~~ ~ Issue Date: ~ j ~ ~ ~ ~ Permit Fee: $ ~ , ~~
JOB ADDRESS
~- I ~ ~ I ~n (~ u~ n ~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
,Z. OWNER MAIL ADDRESS Zlp
~~ ~Gv~c~~SOr~ HONE
~"~3 - ~~~'
3. CONTRACTOR (~ j~ c~ ~ , '~ ~~~~~ ~ AILS D~~~ ~ ~ ~ ~ ~ ~ ~ PHONE rn ~~~r
1L/l (~~i.~- vl ~ G/~ ~ LICE ~' _ I L~
o
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: n - ~ f )
7. Sq. Footage of Structure (IRdBaing BasemeDt aoa Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^ Dev.Permit
EIev.Cert.
10. Floodplain: FrlDge 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 _
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
' NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioriing, 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 selforth
above and in accordance with the codeslordinances of the City of Blair and the State of
Nebraska. I u erstand chat this permit is void if work is not commenced within 180 days,
is not com to within 2 years of the date of issuancgg, or if work is abandoned for six (8)
months o long , whichever is eaNl~. - On I) 11 /~ ~
DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached Co plet~j Plans Att hed ^
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic
Remote
Building
Footings Drywall
(before finish)
Framing. Final ~~~ ~~~~~'
Electrical
Rough-in
Final
Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final ~- <~'_'~
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
'OUNDS PRT6: Blelr, NE ~ Rev. OafB:
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