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BP7777 .~ ~UILDING PERMIT APPLICATION ~~ - Jurisdiction of City of Blair, Nebraska Permit Fee: 218 South 16th Street Issuance Fee: Blair, Nebraska 68008 7 7 7 7 Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit Application Date: '" ~~ 1 ~. ~' Issue Date: ~ JOB ADDRESS ~f/ `x+ l LEGAL 1. DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET OWN 2. MAIL ADDRESS ZIP PHONE CONTRACTOR 3. MAIL ADDRESS ZIP PHONE 4. Class of Work: O N O ADDITION O REMODEL 5. Describe Work: ~ ~~~Q.~ O Finished Basement O Unfinished Basement 6. Total Sq. Footage (inoii,ding easement aRd Garage): Total Finished Area: © ~ 7. Valuation of Work: $ ~~j Floodway O Yes O No 8. Floodplaln: 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 furtheragree that construction covered by this permit application shall not be commenced until I have received a copy of this application form signed bythe 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 withjn 2~earA'~'fg date of issue. SIGNATURE OF Comment: O Site Plan Attached ~~~~~te Plans Attached Approximate Completion Date ,/ Inspections Required and Fees Utilities Sewer Water Service Septic Remote Stop Box Card Building Footings Drywall (before finish) Framing Final ~ " ~ ` y7 Electrical Rough-in Fixtures Final Permanent Service Temporary Service DATE Mechanical Rough-in _ Final Plumbing - Ground Work Rough-in _ Final WHEN PRO Approved By: A\C THIS SPACE) THIS IS YOUR PERMIT POUNDS PRTG: Blair, NE ~ Rev. BI96 1~- -- ----- -- - - - - ----- _ _ . . ~~ -TBI~ILDING INSPECTION R ---~ EPORT `.., CITY OF BL;AIIt [) WASHING ON COUNTY ~ 0~ ~; -- -~ ~' LOCATION OF ~ . $CTION:. , / ~~ ~ °-~ ~ NAME OF OWNER: '~~-? ~~~~~ ~ ONTRACTO . fj - ~ ~ A~-~ DATE INSPEC'IgONREQUESTED; ~' ~~ ~~~ ~. PE[tMIT N0: ~ l TIME INS..PECfION REQUESTED:. l~ ` TYPE OF INSPECT ~ ION REQUESTED: ~ BUILDING: f FOOTING ^ F~~G .~ DRYWALL ~ FINAL ` LJI7LITIES: •~ '~ _ ^ SEWER TAP ~ SEWER ~ SEPTIC ' 0 WATER TAP - ~' ~ REMOTE ~', ^ WATER SERVICE ~, ELECTRICAL: ~~.` ~, ~ ^ ROUGH IN O FIx'I'UxFS ~ ~~ ~ MOTORS PERMANENT SERVICE ~ TEMPORARY SERVICE MECHANICAL: O ROUGH-IN . ^ A/C ^ FINAL PLUMBING: GROUNDWORK ^ ROUGH-IN ^ FINAL <' ~' -, " ._. ~ ," RESULTS OF THE INSPECTION: SSED (sEExo~s ^ FAILED (sue xa~sl - ,