BP6943~UIL®INC PE~I~IITA~PLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: E~ .~) 3 -~i ~ Issue Date:
Permit ~ ~ ~ 3
~~21P is
Permit Fee: $ ~~ . ~ ~
JOB ADDRESS
l15 ~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER ~e~ ~ L ADDRESS // r ~ Z P
~/ ~~ ~ P~~ ~3
HONE
3, CONTRACT R MAILADDRESS LICENSE ND.
USE OF BU LDI
4. ~_
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ~EPAIR ^ MOVE ^ REMOVE
6, Describe Work: ~ ~~Q
7. Sq. FOOtage Of StrUCtUre (Including Basemen) and Garage):
8, Change. of Use From: Change of Use To:
g, Valuation of Work: $ ~ 5r'd ~ G G
10. Floodplain: Floodway Yes^ No ^ Dev.Permit EIev.Cert.
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 8Y 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 bythe Building Inspector and 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 completed within 2 years of tie date of issuance, or if work is abandoned for six (8)
montt}~r longer, gyp ch ver i~~gFliest.
~ i...a ~r./e oft C~( a/, ern aa~~~ ~-1 ~ ~91v
SIGNA~RE OF OWNERICONTAACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~ J3- ~' ~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~ ~?~ '~ ~
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work .
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appr~ ~y:,
c-~` -w ~
CATION
POUNDS PRTG: Blalr, NE Rev. °~~