BP7844~s~ ~~~, BIJIL
Permit Fee: ~~O ! ~ ~
Issuance Fee:
Deposit Receipt #:
Application Date:
Issue Date:
JOB ADDRESS
0
4`
LEGAL
1. DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
0 EFL
2. c ~ ~~~ rMAILADDRE S J
f "~` ~ ~ ~~ PHONE
COy~ACT
3. 1 " l.~ . ~ n n.` i n MAIL ADDRESS
2 ~ ~t.~ I
~1' . ZIP
~O PHONE
2 ~ ~~ G ~
4. Class of Work: NEW O ADDI ION O REMODEL
5. Describe Work: (] Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRCluding Basement and Garage>: Total Finished Area:
7. Valuation of Work: $ ~c `~ ~ ~ ~~
Floodway O Yes f7 No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE Elev. Cerl.
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
DING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 • Fax (402) 426-4195 Permit-
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 copyof this application form 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 is not completed ithin 2 y ars of to of issue.
~-~
SIGNATURE OF 0 ER/CONTRACTOR DATE
Comment:
O Site Plan Attached O Com lete Plans Attached
Approximate Completion Date ~ ~` f ~ r ~ ,7
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough•in
Final
Temporary Service
Mechanical
Rough-in
I Final
Plumbin~ -
Ground Work
Rough-in _
WHEN PROPERLY VALIDATED
lpprov d By: ,
S
~/1~ ~~~i~ ,/ L
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final t ~" 2 3 ~~
Fixtures
Permanent Service
A1C
Final
THIS SPACE) THIS IS YOUR PERMIT
~-r~ D ~r )
7544
POUNDS PRTG: Blair, NE Rev. 8196