BP7892}, BUILDING PIERMIT ~PPLIC~4TION
~5.~ Jurisdiction of City of Blair, Nebraska
~ePmit Fee: 218 South 16th Street
Issuance Fee: ,' , Blair, Nebraska 68008 7 8 9 2
Qep~i~ Receipt #: - (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ ~~ (c1~'T Issue Date: ~~~ ~ 1 7
JOB ADDRESS
l/D l
D~ .
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. ~~ MAIL ADDRESS ZIP PHONE
CONTRACTO
3. ~ MAIL ADDRESS
-~ ~f ZIP PHONE
~(2 c~ -- Z~, ~ Z
4..Class of Work: O NEW O AD ITION O REMODEL
5. Describe Work: ~ ~ I ~ O Finished Basement O Unfinished Basement
~ ~1.2.1~,00
6. Total Sq. FOOtage (Including Basement and Garage): TOtal FInlShed Area:
7. Valuation of Work: $ ~ ~Qp~o
Floodway O Yes O No
8. FIOOdplaln: Dev. Permit Elev. Cert.
Fringe O Yes O No BFE
9. Current Zoning;
10. State Fire Marshall Required: O Yes O No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: O Yes O No Waiver Approved .
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date R ~ l s~~
Inspections Required and Fees
Utilities
Sewer _
Septic _
Water Service
Remote
Stop Box Card
Building
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air Footings Drywall
conditioning, and septic systems. By my signature below, I acknowledge that payment (before finish)
of the building permit application fee does not constitute issuance of this building Framing Final ~' Z~'~/1
permit. I furtheragree that construction covered by this permit application shall not be
commenced until I have received a copy of this application form signed bythe Building El
t
i
l
Inspector. ec
r
ca
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
SIGNATURE OFOWNER/CONTRACTOR DATE Mechanical
Rough-in A\C
Final
Plumbing _
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS
THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. Bl96
1.
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