BP7819- ~UiLDII~Ca PERMIT ~4PPLICATI®N!
Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ 5 •~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 g 1 g
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ ` ~ ' ~ ~ Issue Date: ~~ ~' ~ -]
JOB ADDRESS I ~~~ ` ^, S~~ ~~ '
~.J ~L
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER ~u~ Kn ~ MAIL ADDRESS
2. ZIP ~~ ~ PHONE
3. CONTRACTOIj , ~ ~f C3 ~ ~ O `t S ADDI ~ I ~ J V m W 1QZIP ~ I Z~ ~~ ~~~ / /
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: (~p~-~ - ~ ~(-e ~' ~ 0..` O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRDtuding Basement ana Garage>: Total Finished Area:
7. Valuation of Work: $ ~ ~ ~ , ~~
Floodway O Yes O No Dev. Permit
8. FIOOdplain: Fringe O Yes O No 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
13. Minimum Setbacks: Front
O No
O No
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 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 thatthis permit is void if work is not commenced within
180 days or is not completed within 2 years of date of issue.
OF
/ [/-
DATE
Comment:
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date ~~' f y' ~ ~
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
F
i Final ~"~~~7
ram
ng
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN S SPACE) THIS IS YOUR PERMIT
Approved By: Q A /~
POUNDS PRTG: Blair, NE // Rev. 8196
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