BP7089BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 _l
(402) 426-4191 Permit
Application Date: ~~~ I ~ I ~,O Issue Date: i5 ~~ ~ `mil ~O Permit Fee: $ ~ (~ . C~
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4. USE OF BUILDING
5. Class of Work: EW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ®Q i n _ ~ e~ `, ® ~ .~ ~-
7. Sq. FOOtage Of StrUCture (Including Basemen and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ a r ~ ~ ~ ~ ~ (~
Floodplain: Floodwey Yes ^ No ^
10 Dev. Permit Elev
Cert
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Fringe Yes^ No ^
BFE .
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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 BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical,. plumbing, heating, ventilating and air condi-
tioning, and seplic systems. By my signature below, I acknowledge that payment of the
building permit application fee does notconstitute issuance of this building permit. I further
agree lhat 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 Ciry 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 (8)
months or longer, whichever is earliest.
OWNERrCONTRACTOR ORAUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ ' ~ ~ "'~/
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~ o' Z l ~ ~~
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
SIGNATURE OF OWNER~(rt`OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS Y~JR PERMIT
Comment: Approved By:
POUNDS PRTG: Blelr, NE U Rev. 08/85
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