BP6968r ~ s--
~.Jtaris~iicti~rt ®f City ®f flair, Nebraska
218 ~®uth 18t~t Street
flair, Nebrska 68008
w (~02) ~~6-4191 ~, ~ Permit®
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Application Date: ~ ''° Issue Date: < __ Permit Fee: $ ~ ~~~ ~ ~~(~
JOB ADDRESS LG~ f ~
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LEGAL
1 LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
ADDRES~ ry ~ ~
2 °IWNER ~
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3. C NTRA T R ~ MAILA DRESS
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~ PHONE LICENSE NO.
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USE OF BUILDING
4.
5. Class of Work: NEW - ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~,~ ~ ~ ~ ~ ~ ( ~, ~ ~ _ Ca ~ ~,
7. Sq. FOOtage of StrUCture (Including Base ent and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ L{ i `~~"-~ (~ , ~~ L~
I
Flood lain: Floodway Yes ® No ^ Dev. Permit
10
p Elev
Cert
.
Fringe Yes® No ^ BFE .
.
11. Current Zoning: Site Plan Attached ^ Com lete Plans Attached ^
12. State Fire Marshall Re wired: Yes ® No^
q Approximate Completion Date ~ ~ ~ ~ `~ T ~
Inspections Required and Fees
13. Special Use Permit Required: Yes ® No ® utilities
Sewer Tap Water Tap i
14. Variance Required: Yes ® No Sewer Water Service
15. Minimum Setbacks: Front Side Rear septic Rem to ~ ~
~
16. Sidewalk Required: Yes No ^ Waiver Approved ;
,~
Building
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
NOTICE Framing Final
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
havereceivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped 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
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) Mechanical
months or longer, whichever is earliest.
Rough-in ABC
SIGNATUR~OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
~ ®°
~°
G Final
Plumbing
Ground Work
f
SIGNATURE OF OWNER (IF OWNE
ILDER) DATE Rough-in Final
WHEN PR®PERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT ~
Comment: Approved By:
POUNDS PRTG: BIeIr, NE Rev. OB~95
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~.~ -
® ~~ ,-
~:.CTTY OF BLAIR ^ WASHINGTON COUNTY ^ .OTHER
" ~ '' LOCATION OFINSP,ECTION: ~- ~~~ ~`~--`?-~ = ~- ~ ~ `_~
F- 'NAME OF OWNER: ;°~ : ~ CONTRACTOR, ~ . - - •,
C ~ ~ _ ~~
~~ DATEIN$PECTION REQUESTED: ~~ ~1 ! ~' ' PERMIT N0: %= ~ `~ ~ ~ y~
r.. -TIME INSPECTION REQUESTED: ~ .F'` , ~`
i. TYPE OF INSPECTION REQUESTED:
E:
k BUILDING:
E, ^ FOOTING : ^ FRAMING . ^ DRYWALL ^ FINAL
~',.. i
.UTILITIES:
I
,^ SEWER TAP ^ SEWER ^ SEPTIC ^ WAT'ER,TAP ; ,
4 ., ^ REMOTE ~ i
WATER SERVICE
~' ~ ELECTRICAL:
- ~~ ~ ~
^ ROUGH IN ^ FIXTURES, , ^, FINAI: ^ MOTORS _
~.. -
~ ~
•~;
`. PERMANINT SERVICE ^ TEMPORARY SERVICE
- ~
~; MECHANICAL:
~: ^ ROUGH _IN ^ A/C ~ ^ FINAL
PLUMBING:
~. i,
^ GROUNDWORK, ^ ROUGH-IN ^ FINAL ',
RESULTS OF THE INSPECTION; - ^ PASSED ~s~rroTES) ~•F~ILED ~s~rrorFS)
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NO'I'ES/REMARKS: ~~¢ ;+ f ~- ~~ .,~ ,~ ,.. ~., s~ ,~
r.4~ r~°"'t ~a aJ ',:--. ~/. ~.G 1-. ~ Il,ev P+.r,r -.~. .G lT r'•.,w
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k INSPECTOR: ~t ~ ~ + _ ,=~^` ~ , ,~~ s,1 .~,- ."~,,._ - _ - ----- - --- --- II
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DATE .OF INSPECITON MADE ~ ~ °' >'': ~ TIME ~"-r~ ~.:• ~
_ ~ _
.3 ~ F _.
_ CALLED OPPD\ TO CONNECT SERVICE: ' ^ YES ^ N0
WANT OFFICE STAFF'FO CALL OPPD~ ^ YES ^NO BLR 1
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