BP7045BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date -I ~ '2 5 -`l
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Application Date: g`~y" ~ ~ Issue Date: ~"~~ Q~ Permit Fee: $ ~~l/~ ~-C.J
JOB ADDI ES,~ ~ ~
UI ~ ~ ~ ~ ~ (~
b
LEGAL
1 LOT NO. BLK. TRACT
^ SEEATTACHEDSHEET
' DESCR.
MAILADDRESS
O
2 ~ ZI ~ ~ ~ ~E~~!
~ U.
.
,~ ' r ~.!
C NTRACT R
'3 AILADDRESS PHONE LICENSE NO.
. ~
USE OF BUILDING
4.
5. Class of Work: ~ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: CO U i ~ S e G.f -(j-~ (~~ ~ 4
]. Sq. Footage Of StrUCtUre (InGuding Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ a ~~ ~ , ~
laln: Floodway Yes ^ No ^ Dev. Permit
10
FIOOd Elev. Cert.
p
.
Fringe Yes^ No ^ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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 Inspectorand stamped
'APPROVED'.
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 not complete,~'Within 2 years of the date of issuance, or if work is abandoned for six (8)
months er, whichever is ea
SIGNAT E OF OWNERJCONT CTOR OR AUTHORIZED AGENT -~ DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THJ~IS YOUR PERMIT
Comment:
Approved By:
Sewer Water Service
Septic
CATION
Permit
Remote
Building
Footings Drywall
(before finish)
Framing Final 1 D'Z-(mil, f/
Electrical
Rough-in
Final _
POUNOS PRTG: Blelr, NE ~ Rev. OBl85