Application�'` CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
Iva 1
Date: Approximate Completion Date e of �i Site Plan Attache
Estimated Valuation of Project:
777 C
Application for: Permit Fee $4011ssuance Fee $25/Deposit $50 Fee: $115.00 4
Sign Erecting, Awnings (Persign)
Roofing/Siding_
Window/Door Replacement (size change only)
Egress Window (floor plan drawing required)
Swimming Pools with Fence (plot plan required)
Fences (plot plan required)
Decks/Handicap Ramps (plot plan required)
Satellite Dishes/Radio Antenna/Cell Towers (plot plan required)
Gazebos (plot plan required)
Miscellaneous Building Permits (items not covered by one of the above)
Other
Patios/Driveway Permits/Utility Excavation and Curb Grinding
Curb Grind
Length
Utility Excavation
Length Lin. Ft.; Width Lin. Ft
Type: Water ; Sewer ; Other
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Lin. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
Total Permit Fee/issuance Fee
Additional /Description ofprojectif necessary: 1� .-Y A6/ci ��� ��d'C , �/��✓C���
Fc r,I%P�Kr,rM , �C )JAP.,I M,) eA,". 1-9 ferr nPs ®� r� c
PROJECT INFORMATION:
Job Address: 14d9
6�-Oo
Owner: s' Address: 109 6. cl � S Phone#:947960
Contractor:
ME
Phone #:.
Address: / � % C , S � Cell #:
Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic
systems. By my signature below, I acknowledge this building permit application 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 a permit signed by the 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 d-a-yg.Qt is nM completed within two (2) years of date of issue.
Signature of
Date