BP6808Red / -~ ~ ~/ ~ ~ ~ -2. ~ 1 ~ ~ ~tc~ . ~ r(.
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 ~ Permit
c
d ~' ~~ ~ ~
~~'` Issue Date: ~~"" ~ cr_~~ ~ Permit Fee: $ ~ ,~__
Application Date: ,
JOB ADDRESS ~.~~ ~-"'~" - : ,, .
~ ~~_ t ~ ~ ~;;,~ ~" ~ -
1. LEGAL LOT NO. ~ ® BLK. TRA~-~ j ^ SEE ATTACHED SHEET
DESCR. ~ B, ~ f :,~~_
2. 0 NER •: MAILADDRESS r t ZIP PHONE
TRACTOR ~ MAILADDRESS _ ~°~ PHONE LICENSE NO.
3.
"
4. U OF BU LDING
5. Class of Work: ^ NEy~ ^ ADDITION ^ALTERATION ^ REPAIR OVE <-~ ` ^ REMOVE
. ,
6. Describe Work: ;r ~ - ~ ~ _ ®/
7, Sq. FOOtage Of StrUCtUre (Including Basement and Gar ge):
~ ~1 ~'
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ s r ...~
10. Floodplain: Floodway Yes^ No ^ Dev.Permit
Fringe Yes^ No ^ BFE
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 Ream
16. Sidewalk Required: Yes ~ No ^ Waiver Approved
Elev. Cert
APPLICATION ACCEPTED BY I PLANS CHECKED BY ( APPROV~FOR IS~UAt~fE 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 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 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 1 SO 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.
. ~iGN~TUUR~ OF OWNER/CONTOR 0 U~f
~''
! 10RI~EQ AGENT
~ DAT E
f
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
s" ~~ Utilities .
ewer Tap J a) r~ ~~ i~4fl'.~~~t-, Water Tap
Sewer ~~~~ ~~ ~~ Water Service - -~
Septic Remote
r.
~
/~ Building
Footings Drywall
(before finish)
ramina Final
Electrical
rin f~~~ ~~ i '`" Permanent Service ~~-'
~~ ~° Temporary Service
Mechanical
~h-in >:~~ `C~~:=~~~;~~~ ABC /~:~:~
I a~° ~,
Plumbing
nd Work~.~,
SIGNATURE OF OWNER (I NER BUILDER) DATE ugh-in ~° ~ _.. ~--' Final ~'
WHEN PROPERLY VALIDATED (IN THI ;SPACE) THIS IS YOUR PERMIT
Comment: Approved By: , / '
POUNDS PRTG: Blelr, NE - , // Rev. O$/95
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