BP7744~~gl~ r BUIL
Permit Fee: 3®~ d
Issuance Fee:
Deposit Receipt #:
Application Date: ~O-° ~'
Permit 7 7 4 4
Issue Date: ~ " Z~~
JOB ADDRESS ~~~. n ' J~
9~"Ks~~ /
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2 OW ER ~~ AI~DDR S ZIP ~ 07 ~ ~~ ~O~
3 C ACTOR ~ ~ ~~DDRESS _ ZIP ~~~ ~ ~ PHONE
4. Class of Work: O EW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
6. Total Sq. Footage (Including Basement and Garage): Total FInlShed Area:
7. Valuation of Work: $ c~c9om~a ca
Floodway O Yes O No
8. Floodplain: Fringe O Yes f7 No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
DING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 • Fax (402) 426-4195
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 septicsystems. 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.
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 day r s not o pleted w~ in 2 years of date of issue.
SIGNATURE OF OWNER/CO ACTOR DATE
Comment:
O Site Plan Attached O Co plete Plans Attached
Approximate Completion Date ~-° ~~ ~
Inspections Required and Fees
Utilities
Sewer
Septic
Building
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in
Final
Plumbing -
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
A
POUNDS PRTG: Blair, NE
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final 7~` y 7
Fixtures
Permanent Service
A\C
flev. 6/96
RESULTS OF THEINSPECTION PASSED (s~No~rFS) ^ FAII,ED (s~xoTES)
NOTES/REMARKS: