BP7098BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
. 218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
Application Date: / ` ~ (~ ~ ~s Issue Date: ~'~ ~" T ~ Permit Fee: $ ~~ `d~
JOB ADDRESS
1 ZC)Z ~crt.1~~ 4St'~
LEGAL
1' DESCR. LOT NO. BLK. TRACT
^ SEEATTACHEDSHEET
2, OWNER ~~1 16/ ~ r`%/ MAILADDRESS ZIP PHONE
3. CCNTRACTQR ~ I r I Wr l~rlUG7-I ~LyC~RzS ~L.Jrr(G{~ V(~L/l~ J~' PUC//t (/UCH (Q(~f`~ LICENS~C ~~~
r/l
4, USE OF BUILDING
5. Class of Work: []NEW ^ ADDITION ^ALTERATION REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~ ( ~
7, Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ v
10. FIOOdplaln: Flooaway Yes ^ No ^ Dev. Permit Elev. Cert.
Fringe 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 _
ACCEPTED 8Y f PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
U NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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'.
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 (6)
months or longer, whichever is earliest.
SIGNATURE OF
AGENT DATE
Site Plan Attached ^ plete Plans Attached ^
Approximate Completion Date Z "
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
F
i (before finish) ,
Fi
l ~ ~~-~~
ram
ng na
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Final
v Ground Work Plumbing
SIGNATURE OF WNER (IF OWN R BUILDER) DATE RDUgh-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ,n / ~
CATION
POUNDS PRTO: Blab, NE V Rev. 08195