BP6947~UIL®ING PERI~!lT~PLi~ATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 ~ ~ 4 7
(402) 426-4191 Permit
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Application Date: >~ 12" I~J Issue Date: ~~ (2 ~ Permit Fee: $ J~.~
JOB ADDRESS ~ I ~ ~\ I ~~ r~ ~~
V
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER •~~`t A, _~~ (,(~ MAC I~~RESS
T-r \ ZIP PHONE
MAILADDRESS
CONTRAC R
s. ~ ~ Ca~is~r ~ ~~ rJ ~ ~ ~ ~~ ~~ PHO
~-~ ~~~~~ LICENSE NO.
~~a~ ~~ ~ ~~~~
4 USE OF BUILDING
5. Class of Work: ^ NEW
^ ADDITION ^ALTERATION REPAIR R
EMOVE
^ MOVE ^
r
6. Describe Work: ~ r_~-t-c ~1 c -- --~ ~ I(~ ~ )
~ (~(? t. P ~ ~ ~
~
~ (~t1"~2 l.t~ ~=~7'~
7. Sq. Footage Of StrUC1Ure (Including Basement and Garage): /~~ ~1~~~~
t.
Change of Use To:
8, Change of Use From:
g, Valuation of Work: $ 3~ (~~, Q ~
10. FIOOdplaln: Floodway Yes ^ No ^ Dev. Permit
Fringe Yes^ No ^ BFE Elev. 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 _
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~' /(r-~- ~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final lU~~ ~~ ~~'
D NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge chat 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'.
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 OWNERICONTRACTOR OR AUTHORIZED AGENT DATE
Electrical
Rough-In Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS YOUR PERMIT
Comment: Approved By:
" -"~ /,~,, ~i~~
POUNDS PRTG: Blelr, NE ~ ~ Rey Oflr95