BP7075r: i
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
7075
Application Date: 0 ~ ~ ~ - ~ ~ Issue Date: S "l ~1 ' ~ ~ Permit Fee: $ ~~ •~~
JOBADDRESS I
d S C~ i r
1 LEGAL LOT N0. BLK. TRACT ^ SEE ATTACHED SHEET
DESCR.
WNER ~
2
(~ MAILADDRESS ZIP
~ PHONE
2 ~S2~P7
.
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CONTRACT R MAILADDRESS PHONE LICENSE NO.
3. ~~ ~ < r ~O, ~ ~~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ c ~ /~ d ~ U -~ r
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ ~ ~ ~ (~
Floodplain: Flooaway Yes^ No ^
10 Dev. Permit Elev
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 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 completed within 2 years of the date of issuance, or if work is abandoned for six (6)
months or longer, whichever is earliest.
OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ omplete Plans Attached ^
Approximate Completion Date "1 - ~ L~ ~~/ ~m
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
r~
l ~U'~~~'%(/
Fi
Framing na
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
I SIGNATURE OF OWNF~1{ (IF OWNER BUILDER) DATE I Rough-In Flnal
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
+~ c
OUNDS PRT6 -Blelr, NE ~ Rev. OBIB~
9