BP6820Jurisd~yiction of City of Blair, Nebraskaof City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
F,
Application Date: ~ I ~-~ t~ ~`? Issue Date: / f ~ /" ~~ ~ Permit Fee: $ % ~~ ~ ~`~`
JOB ADDRESS (
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
®SEE ATTACHEDSHEET
OWNER ,. ~ MAILADDRESS ZIP ~ c PHONE
CONTR CTOR t. ~ MAILADDRESS _ / t~ PHONEn ,- ,.
4, USE OF BUILDING ~ -~ ~Cr~ ~ =_a ~`g~
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~C ~C~ ~~ C,~C~ r'~'~) C;,,~~:`_ ~% ~ ~ ~_ ~<~'Y~ ~` ~~~~ =
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^ Dev. Permit
10. Floodplain: Fringe Yes^ No ^ 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 _
APP~AT~10`N~ C(EPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
E 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 180 days,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (fi)
OF OWNER~CONTRACTOR OR
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~~ "~" ~' -~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish) s `~ ~L Ct , ~~~°- ~
3 ~ ~ ~~
Framing Final
Electrical
Rough-in Permanent Service
Final Temporary Service
~ ~ ~ ~ /,~v
Mechanical
Rough-in ABC ~ (~, ~ ~~(~,
Final Cry ~ ~~'
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~ ,%
~ J ~ ~_ ~~ ~ ~-~
OUNDS PRTO: BIeIr, NE / Rev. 08l8
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