BPE6872BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
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Application Date: ~ ~- (7" ~ ~ Issue Date: ~ ~~~ ~- ~~ S Permit Fee: $
JOB ADDRESS
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LEGAL
1' DESCR. LOT NO, B~• TRACT
^ SEEATTACHEDSHEEi
2. OWNER ~ /~ ~~ 1' ~ MAILADDRESS ZIP
( ti "~ PHONE
_ MAILADDRESS PHONE
CONTRACTOR .
3. '
~C, ~~ ~~'C7Ll~i ~- Zl~ S . /Gr' ~~ ~ . ` Cry ~ LICENSE 0.
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4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~;~ (~ ~ ° ~ C~~~.
7. Sq. Footage of Structure (Inducing Basement end Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^ Dev. Permit
10 Floodplain: Fringe Yes^ No ^ BFE Elev. Cert.
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 _
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
CATION
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Building
APPLI ION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
NOTICE Framing Final ~~ ~ S y~O
Separa a 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 Electrical
agree that construction covered by this permit application shall not be commenced until I
have receivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped Rough-in Permanent Service
'APPROVED'. Final Tem ora Service
I hereby agree to perform the proposed work in accordance with the specifications setforlh p ry
above and in accordance with ihecodes/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 completed within 2 years of the date of issuance, or if work is abandoned for six (8) Mechanical
months or longer, whichever is earliest.
Rough-in ABC
SIGNATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE Final
~~~~~ Plumbing
~~a~-.,-c..o _ d l '17 "Y-5 Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IjS YOUR PERMIT
Comment: Approved By:
~, ~~„
POUNDS PRTO: Blelr, NE ~ ~.. ~Y' OBI85
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