BP7855- ~UIL®INC PERMIT APPLICATION
~ ~ ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: ~ Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195
Application Date: ~ ~ ~^
Issue Date:
JOB ADDRESS _
I~I
LEGAL
1 . DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER ~~ L
2. ~~~n .~ MAIL D R S
~ ~ Z / ZIP PHONE
~Ctc.i2-
3. CGNTRACTO~~ ~~. ~ ~ MA~ AGRQESS,'~ ~` ZIP ~~ ~~~~1 PH~~~q
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: ~ ~ ~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage IIRDIDdfng BaeemeRt ana Garage>: Total Finished Area:
7. Valuation of Work: $ ~k~(~'~ , t~~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O 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
O No
O No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: O Yes D 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 is of completed within years of date of issue.
~ ~ ~~
SIGNA RE OF 6WNER/CONTR TOR DATE '~'
Comment:
O Site Plan Attached O Com I to laps ttached
Approximate Completion Date ~'
Inspections Required and Fees
Utilities
Sewer _
Septic _
Buildina
Footings
Framing
Permit
7- ~~-~~
7855
Water Service
Remote
Stop Box Card
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbing _
Ground Work
Rough-in _
Final
WHEN PROPERLY V,
Approved By:
. `;
Drywall
(before finish) ,~/
Final ~` 3~ ~ /
Fixtures
Permanent Service
A\C
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: BIair,NE ~ ~ Rev. fl/96
BU~~LDING INSPECTION REPORT
~ ~ ~}
~,yCITY OF BLAIlt ^ WASHINGTON COUNTY ^ f~
LOCATION OF INSPECTION: - ~-°°"' ~~ ~/
NAME OF OWNER: t~ ~~-~~~'~. ~~ CONTRACTOR:r
-DATE INSPECTION REQUESTED: ~l '~ ~ ~ 1 PERMIT NO:. f
TTMF. TNSPECTTON REQUESTED: ~~Z