BP7081BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Permit
701
(402) 426-4191
S-12-~7 S-rZ-ct7
Application Date: Issue Date: Permit Fee: $ ~ ~. ~
JOB ADDRESS
1 ~
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LEGAL
1 LOT NO. BLK. TACT
^ SEE ATTACHED SHEET
' DESCR.
2. 0 N R ~ C..
CC t rl 'e.
~L 'e \ ~` MAILADDRESS _
~ /~ • 2 '-~ (~ p
~a ~Q d PHONE Z
ONTR OR ILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: d `~ c - ~ -~- ~ C(~ O Ce ~ U ~ I"
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ (. (a Q ('~ ~ (~C7
Floodway Yes ^
10 Flood
lain: No ^ Dev. Permit
EIev
Cert
p
FrlRge 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 8Y I 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 chat payment of the
building permitapplication fee does notconstitute 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 (fi)
months or longer, whichever is earliest.
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ ~ ~ ~ -~1
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final 5 ~ ~ ~~ ~~
CATION
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
SIGNATU F W RJCONTR~CT ORAUTHO ZED AG T DATE Final
~^ 1 ~~~`~ Ground Work Plumbing
SI NATURE OF OWNER (IF OWN UILDER) /DATE ROUgh-ln Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
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SOUNDS PRTO: Blair, NE Rev.Oal&
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~~ILI~ING INSPECT.LON, REPORT