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,~urisclictiot-~ of pity of flair, Nebraska ~~~
218 S®uth ~ ~tl~ street ~~
flair, Nebraska 68008
Permit ~ ~' ~~
(402) 4~6-4191 ~ ~ - « ~ ( J
Application Date: ~ ~ ~ ~ Issue Date: ~ ~ Permit Fee; $ ~~~ ~aC~A ~
JOB ADDRESS
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~ ~ ~ ;~`~ ~ c~ (~ ~ 2~ C~ C3
1 . LEGAL LOT NO. BLK. TRACT ~ SEE ATTACHED SHEET
DESCR.
WNER (~~ ~ ~ ~~~ ~ ~ MAILADDRESS~ J ZIP ~j PH E ~ .
CONTRACTO MAILADD SS PHONE LICENSE NO.
3. c ~t ~ ~~ ~ v ° ~ ~ ~Y` ~ _ ~ `° ~ .
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE I ^ REMOVE
6. Describe Work: -° ~~ ~ % t'7 ~ ® ~ ~ . ~° ~' cc r'` - • ~ U`~ ~ l Ci ~
7. Sq. Footage Of StrUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ CJ ~ ~~1 ~ , ~
1®. FIOOdplaln: Floodway Yes® No ® Dev. Permit Elev. Cert.
Fringe Yes® No ^ gFE
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 _
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
N®TICE
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 notconstitute 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 (8)
months or longer, whichever is earliest.
SIG~t+~7`UREQF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE
~~ '
OF OWNER (IF
Site Plan Attached ® Complete Plans Attached ~~.,,~
Approximate Completion Date r -- .~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~f ] ~~
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
_ _ Ground Work
BUILDER) DATE I Rough-in Final ,
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
comment: Approved By: ~`
.. ....... ....,_ ........~ Rav. Oel
x~ 1~ E .T
CITY OF B LAIR
LOCATION OF INSF
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^ WASHINGTON COUNTY ~ OTHER