BP7428BUILDING PERMIT APPLI
~~ ~ ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195
Application Date: ~' ~ ~~ ~ ~ Issue Date:
CATION
Permit ~ `~ 2 8
~~ 2-~'~
JOB ADDRESS
LEGAL
1. DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ,/ ~ ~ I II
111 I (~ MAIL ADDRESS ZIP PHONE
3, CONTRACTQBL-~n ~ ~a~~ +
I ~ ~~MA~ AD ~ EL~SS ~%~ r ~ ZIP ' / - PHON//E
~~~~ ~lL~ ~
4. Class of Work: ~ NEW O ADDITION O REMODEL
5. Describe Work: ~~ ~~ /~ ~ IQ Ltn Vv 1/t ~ ~ J O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRoluding Ba6emeR- and Garage): Total Finished Area:
7. Valuation of Work: $ ~~QQ~, Q
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
O No
O No
Side Rear
14. Sidewalk Required: O Yes 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 copy of 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 i not leted within ars of date of issue.
SIGNATURE OF OWNER/CONTRACT DATE
Comment:
i6 PRTG.-Blair, NE
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date (od ~~~~
Inspections Required and Fees
Utilities
Sewer_
Septic _
Building
Footings
Framing
Electrical
Rough-in
Final
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~ ~ "Z~ ~ l~
Temporary Service
Mechanical
Rough-in _
Final
Plumbina -
Ground Work
Rough-in
Fixtures
Permanent Service
A1C
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 6196