BP6988BOIL®INC PER11111T APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
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Application Date: Issue Date: Permit Fee: $
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JOB ADDRESS
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LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHEDSHEET
2, OWNER MAILADDRESS ZIP ~/ ~ /P}d~E~
(?
3, CO R CTOR MAI DD ESS P NE LICENS NO.
USE OF BUILDING
4. ~ '~ D
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE.
6. Describe Work:
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ J
10. FIOOdplaln: Floodwey Yes ^
Fringe Yes^ No
No ^ Dev. Permit Elev. Cerl.
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 _
CEPT~ -ED BY1 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 notconstitute 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'.
hereby agree to perform the proposed work in accordance with the specifications set forth
above and in ac rdance with the codes/ordinances of the City of Blair and the State of
Nebraska. I u erstand chat this permit is void if work is not commenced within 180 days,
is not co ed within 2 yea the date of issuance, or if work is abandoned for six (8)
nt o r, whic is ear le _ ~
SIG URE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Compl~~~~~ tsached ^
Approximate Completion Date (o
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 I Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) T IS IS YOUR PERMIT
Comment: Approved By:
,r A. ~ ,1
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POUNDS PRTG: BIeIr, NE Rev.OBIB5