BP6939
JOB ADDR SS
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1 LEGAL NO. BLK. TRACT ^ SEE ATTACHEDSHEET
DESC , a,,,
OWNER MAILADDRESS ZIP PHONE
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3 CONT ~,rR a MAILADD ESS ~ PHONE ,,-~ LICEN~6N0.
USE OF BUILDING
4.
5, Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
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6. Describe Work: ~-,~
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~ ~ - ~
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7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): c
$, Change of Use From: Change of Use To:
~~
g, Valuation of Work: $ ~. ~~
Floodway Yesb No ^ Dev. Permit
10. Floodplain: F
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^
Y
^ N
EIev.Cert.
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11. Current Zoning: Site Plan Attached ^ Complete P ans A ach~ ^
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12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Da u
te
Inspectio ns Required and Fees
13. Special Use Permit Required: Yes ^ No ^ utilities
Sewer Tap Water Tap
14. Variance Required: Yes ® No ® sewer Water Service
15. Minimum Setbacks: Front Side Rear Septic Remote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building
APP ICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
~ (before finish)
~
NOTICE Framing Final
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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
Electrical
building permit application fee does notconstitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have receivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped Rough-in Permanent Service
'APPROVED'.
Iherebyagreetoperformtheproposedworkinaccordancewiththespecificationssetforth Final Tem ora Service
p ry
above and in accordance with the codes/ordinances of the City of Blair and the State of
Nebr ~Ca. I understand that this permit is~~vv~id if work is not commenced within 180 days,
is n co~pleted ithi ears of t)t~ate of issuance, or if work is abandoned for six (8)
l
h
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Mechanical
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ver~ear
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Rough-in
ABC
SI NATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
i Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SP~~IS IS YOUR PERMIT
Comment: Approved By: _
POUNDS PRTG,-Blelr, NE Rev 08195
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