BP7754r o~~UILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ ~~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 7 5 4
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ .~ Issue Date: `~ ~~
JOB ADDRESS ~
lei ~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. ADD S r ZIP ~PF~ONE _
CON R MAI
3. .~~ RESS
~ ZIP PHON
Q
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRCIudIRg BasemeBt aRd Garage): Total Finished Area:
7. Valuation of Work; $
~~~~ ®~
Floodway O Yes O No
8. Floodplain: Fringe ~ Yes O No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes ~ No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes
Side Rear
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 copyof 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 that this permit is void if work is not commenced within
180 days or is not completed within 2 years of date of issue.
IGN RE OWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached G~~~~~ Plans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbin _
Ground Work
Rough-in _
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~ ~ ~ _
Fixtures
Permanent Service
A\C
Final
WHEN PLOP RLY VALI TED (IN TH
Approved By: G
THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. BI96