BP6864,.
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Jurisdiction of City of Blair, Nebraska `~,
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit®
Application Date: ~ ~ ~- ~ n., ~ ~ ~ Issue Date: ~ <-~ i ~- ., f _-~ Permit Fee: $ ~~~r~ . ~
JOB ADDRESS ~ ,r--~ ~ °~ ~
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LEGAL.
1 ' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
OWNER r MAILADDRESS ~
~ g t + ~, ZIP PHONE
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3 CONTRACT R qtS, , h 4 MAILfADDRESS (( /f.
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I NSE
PH~`ONE L CE NO.
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USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10 Floodplain: 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 ^
Site Plan Attached ^ Complete Plans Attached ^
~ . ,,, u. ,s~,
Approximate Completion Date d ~~ --
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
14. Variance Required: Yes^ No®
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE 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'.
hereby agree to perform the proposed work in accordance with the specifications setforth
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,
i cnpleted w~' m 2 years of-the date of i~uance, or if wor ~s abandoned for six (8)
r-long~'~ is ever is earli, ~'t~"°`~. ° , ~ j`P~ ~~~~
SIGN~URE OF OWNERJCONTRACTOR OR A ~~O~I~LED ACHE ~~r ~ DATE
~,~
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SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final i "=~ c f~ ~~'
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Final ~~- t .l
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS ~ YOUR PERMIT
Comment: Approved By: ~'~ ~ ~"`~
~ C r~ r,,~' ~ ' ~~.
e 3sF``~t
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POUNDS PRTG: Blelr, NE ~+~ Rev. 08/95