BP7263BUILDING PERMIT APPLICATION
~d Jurisdiction of City of Blair, Nebraska
Permit Fee: _ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 2 6 3
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
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Application Date: ~ ~ ~~ Issue Date:
JOB ADDRESS
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LEGAL LOT N0.
1 . DESCR. BLK. TRACT
^ SEE ATTACHED SHEET
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C NTR C OR
3. ~ ~ o MAI DRESS
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4. Class of Work: O NEW ADDITION O REMODEL
5. Describe Work: ~ ~ O Finished Basement O Unfinished Basement
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6. Total Sq. Footage (IRCIudIBg Basement and Garage): Total Finished Area:
7. Valuation of Work: $ ~ ,Q~~ (~ , C~ d
Floodway O Yes O No
8. Floodplaln: 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
O No
O No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: O Yes O No Waiver Approved .
NOTICE
Separate permits are required for electrical, plumbing, heating, 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 copyof 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.daVS or is not comoletedwithin 2 years of date of issue.
SIGNATURE OF
Comment:
/~"~-~
~-~-
DATE
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date l ~ ~ ~ ~~ ~~ ~
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbing -
Ground Work
Rough-in _
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~' ZG'~/7
Fixtures
Permanent Service
Arc ~
Final
WHEN PROPE VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
POUNDS PRTG: Blair, NE ~ ~ Rev. 8/96