BP7524Permit Fee: ~U
Issuance Fee:
BUILDING PERMIT APPLICATION
°~ ~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 7 5 2 4
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: / /~~ Issue Date: ` ~
JOB ADDRESS
LEGAL
1. DESC LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
0 N
2. MAIL ADDRESS ZIP PHONE
7.3 -S.~
3 RACTO _> ,~~ MAIL~ESS -~ / ZI~ /~ PHONE
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: / w Q Finished Basement O Unfinished Basement
U ~~ .
6. Total Sq. Footage (IROIBaiRg easement ana Garage): Total Finished Area:
~>
7. Valuation of Work: $ ~j(~~
Floodway O Yes O No
8. FIOOdplain: 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
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 copyof 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 codeslordinances 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.
SIGNAT RE OF OWNER/CONTRACTDR DATE
Comment:
O Site Plan Attached ~ l~0 Cp~l~ Plans Attached
Approximate Completion Date -r l
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
Framing Final y'~ "~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbin -
Ground Work
Rough-in
Final
WHEN PROPER ALIDATED (IN THIS
Approved By: ~ ~,
A1C
THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. 8196
- _ BUILDING-INSPECTION REP®RT =
' TY OF$LAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: ~~~~ ~ ~ ~~~~ ~ ~
NAME OF OWNER: (~ ~2' r/ CONTRACTOR: ~ ~~r/~~
DATE INSPECTION REQUESTED: ~~ ~'~ ~ pERMITNO: ~~~~~_
TIME INSPECTION;REQUESTED: ~r ~" ~'
t
TYPE OEINSPECTION-REQUESTED: -_
BUILDING:-
71~-
^FOOTING ^ FRAMWG : ^ DRYWALL AL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
REMOTE ^ WATER SERVICE
ELECTRICAL:
^-ROUGH W ^ FIXTURES ^ FINAL . ^ MOTORS
^ PERMANENTSERVICE , ^~TEMPORARY SERVICE .
MECHANICAL: --
', ^~ROUGH-IN ^ A/C ^ FINAL =
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: SSED (s~rroTES~ ^ FAILED (saa rroTFS~
NOTES/REMARKS: