BP6970~' ( fir-, r - ~~ ~i~ ~ ~ ~.~ ~~~ ` ~ I 'i~ n /\
~.d ~ ~ r 1~~~~ ~ :~_-.A ~~~'L ~ ~ ~ u ~~ ~~~_'L~-iii
Application Date: . ~ ~ ~ `~ Issue Date: ~ f ~ -_~` Permit Fee: $ r l
JOB ADDRESS ' *~ ~ /I C (~~ ~ ,_ ~ ~ .G ~`
~ _ 1~ l~1 ~ °=-~ ~ ~~
LEGAL
1 LOT NO.. BLK. TRAGT
^ SEE ATTACHED SHEET
• DESCR.
2, 0~ ER MAILADD SS (] ~J ZIP 1 PHONE
C NTRA TqR --~ MAILA
3 ESS PHONE LICENSE NO.
,
USE OF BUILDING
4.
5. Class of Work: EW ®ADDITION ^AL.TERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ U ' ~ ~ c~ /~ ~ ~~ ~ .= ~ ~ (~ -~ ~ ~ t
7. Sq. Footage of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ ((~ i (c} ~
10 Floodplain: Floodway Yes ^ No ^ Dev. Permit
i
® Elev. Cert.
Fr
nge Yes
No ® BFE
11. Current Zoning: _ Site Plan Attached ^ Complete Plans Attached
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~~ ~ "~
Inspections 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
APPLICATION ACCEPTED 8Y PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
r
<
` (
~
(
NOTICE Framing
,
~
k , , ~ f
~
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
have receivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped Rough-in Permanent Service
~APPR®VED~.
I hereby agree to perform the proposed work in accordance with the specifications set forth 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
SIGNAIURE F OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE Final
,~ - Plumbing
'~ ~ ~
~ Ground Work
SI NATURE OF OWNER (I OWNER BUILDER)
DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ,,-~ ,r
.~ ~,, ~~"
,~..~.,., .,.,r,...~_~_ .~.- Rev. 0811
-~- _ . -
__
IL
INS. - _-E C I E T
;;
G
i
E [~~ CITY OF BLAIR ' ^ WASHINGTONCOUNTY ^ OTHER.
~ ,-... - -
LOCATION OF INSPECTION: ~~ ~~`~~ ~~ ~": '"~ ~ "'~~
~.
~. NAME OF OWNER ~ ~"> r'= , s, ~- ~ r ~. ~ ~ ! CONTRACTOR ~%frf -,~r',• f ~-y, ' ~'
~_ - ,1.. tip - - -. -. i
k DATE INSPECTION REQUESTED: PERMIT NO ~ `'~~`'
f
' TIME INSPECTION REQUESTED::
k
f TYPE OF INSPECTION REQUESTED; {
F
F_ - ..
L
~: BUILDING; ,~ ~ = ~ ~
. ,; ~ ~ ~,
1, ^ FOOTING ^ FRAMING ^ DRYWALL [~~IrTAL `~"~~ .- -- 4 ~~~;f `~' "`'F_ `` 1
E- U~'ILITIES:
~~ . i
~ ~ I
~. ^ SEWER: TAP < ^ SEWER ^ SEPTIC ^ WATER TAP
~. .: ,. ':
REMOTE ^-WATER SERVICE -
ELECTRICAL: .
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
..
C ^ PERMANE_ N_ T.SER~ICE. ^ TEMFORARY SERV-ICE
f.
.MECHANICAL:
~•~ ~ ~ _.
i
^ ROUGI~-IN ^ A/C ^ FINAL
[ ,PLUMBING:
^ GROUNDWORI{ ^ ROUGH-IN ^ FINAL j
RESULTS OF THE INSPECTION: "ASSED (s~rroTES~ ^ FAILED (sue rro~s~
NOTES/REMARKS: