BP7304- BUILDI
Permit Fee: ~~~
Issuance Fee:
Deposit Receipt #:
Application Date: ~~ Q
CATION
Permit ~ ~ 0
Issue Date: ~~~ ~~
JOB ADDRESS ~~
LEGAL
1 . DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNE
2. L MAIL ADDRESS ZIP PHONE
CONTRACTOR
3. MAIL ADDRESS ZIP PHONE
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: - O Finished Basement O Unfinished Basement
~ ~ C~ er ~ear~
6. Total Sq. FOOtage (Including Basement and Garage): Total FInlShed Area:
7. Valuation of Work: $ ~ ~~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE Elev. Cert.
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
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 copy of this application form signed by the 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 days or i~ not completed within 2 years of date of issue.
SIGNATURE
Comment:
DATE
O Site Plan Attached 9/ ~0~'17~ Plans Attached
Approximate Completion Date -~~
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Iv-U-Vb-~~ A~
Buildin
Footings Drywall
(before finish)
Framing Final ~ ~ 7 U ~ y ~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin _
Ground Work
Rough-in
Final
WHEN PROPE VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: _
NG PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 • Fax (402) 426-4195
POUNDS PRTG: Blair, NE Rev. e196
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