BP7700BUILDING PERMIT APPLICATION
Permit Fee: ~~ •c~~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 7
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: -~ - ~ ~ "~ L Issue Date:
JOB ADDRESS -7 ~ n ~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~\'\ ( ~
U Y~y,~(~
._ MAIL ADDRESS ZIP PHONE
1
CONTRACTOR ~ MAIL ADDRESS ZIP PHONE
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ~(j~~ --- ~ ~~~ , < / ~--~Z~~~~ O Finished Basement O Unfinished Basement
' ~ ~L~ U~ I '1 G( ~ ~ ~~
6. Total Sq. Footage flR~ludlRg Ba9emeRt and Garage): Total Finished Area:
7. Valuation of Work: $ '3 ~~j(~, C ~
Floodway O Yes
8. Floodplain: FrlRge O Yes O No
O No Dev. Permit
BFE Elev. Cen.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
O No
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'pr is not col~rpleted within 2 years of date of issue.
./~.
SIGNATURE
Comment:
DATE
O Site Plan Attached O CompJ~te Plans Attached
Approximate Completion Date ~~ `~ /
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
~ Temporary Service
Mechanical
Rough-in
Final
Plumbin
Ground Work
Rough-in
WHEN PROPERLY VALI '
Approved By: ~/,
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final S- Z~ ~
Fixtures
Permanent Service
A\C
Final
N THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE j ~ \ Rev. B/96