BP7419BUILDING PERMIT APPLICATION
Permit Fee: ~U . ~~~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 419
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
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Application Date: ~ 'Z~~ ~ ~ ~ Issue Date: ~ " Z ~' c1
JOB ADDRESS
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LEGAL
1 . DESCR. LOT NO. BLK. TRACT
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- ~ ~'" \~ ~ ^ SEE ATTACHED SHEET
OWNER MAIL ADDRESS
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i~l a ZIP PHONE
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CONTRACTOR MAIL ADDRESS ZIP PHONE
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4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ~~~ ~ ~.f i i-10 12 X ~ 0 I G~ e c~ia~`-' Finished Basement O Unfinished Basement
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t). Total Sq. Footage (Including Basement and Garage): Total FInlShed Area:
7. Valuation of Work: $ ~ v~0.O C~
Floodway
Floodplain:
8 D Yes D No Dev. Permil
Elev. Cert.
.
Fringe D Yes D No BFE
9. Current Zoning:
10. State Fire Marshall Required: O Yes ~ No
11. Special Use Permit Required: O Yes ~ No
12. Variance Required: O Yes Flo
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes
Side Rear
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 is not completed within 2 years of date of issue.
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SIGNATU E OF OWNERICONTRACTOR DATE
Comment: /~'~E.~'~ ~~~ ~~~~
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Site Plan Attached O Complete Plans Att ched
Approximate Completion Date pZ°C ~ ~ ~.~/ I ) ~ ct ~
Inspections Required and Fees
Utilities
Sewer
Septic _
Water Service
Remote
Stop Box Card
Buildin ~
Footings / ~ Drywall -
(beforefinish)
Framing ~ Final -
Electrical
Rough-in / Fixtures
Final / Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbin _
Ground Work
Rough-in
A\C
Final
WHEN PROPERLY VALIDATED
Approved By: ~
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair. NE /~~~~ Rev. 8196
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