BP7015BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 ~ Q ~ j
(402) 426-4191 Permit
Application Date: l s ~~ Issue Date: ~ ~ Permit Fee: $
JOB ADDRESS rJ~
LEGAL
1 ' DESCR. LOT NO. tK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL DRE , : ZIP
M~ PHONE .
3. CONTRALTO MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~'~~/ - ~ ~
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ l ~~~ ~ U
Floodway Yes ^ No ^
10. Floodplain: FriRga Yes^ No ^ Dev. Permit
BFE EIev.Cert.
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
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 notconstitute issuance of this building permit. I further
agree chat construction covered by this permit application shall not be commenced until I
have received a copy of this application form signed byihe 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.
SIGNATURE OF OWNERICONTRACIQR OR AUTHORIZED AGENT
OF OWNER (IF OWNER BUILDER)
Site Plan Attached ^ Complete lans ached ^
Approximate Completion Date dll3n~~~o
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish) ~j
Framing Final Q ~2~ ~ ~~
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
DATE
Rough-in ABC _
Final
Plumbing
Ground Work
DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~`~
POUNDS PRTG: Blelr, NE Rev.OB!95