BP6991Application Date: `~~" I ~' Issue Date: `~~'"~~ ~f ~C`~ Permit Fee: $ •°
JOB ADDRESS ~~ ~~ .,,/
LEGAL LOT NO, BLK. f TRACT
1 ' DESCR. ^ SEE ATTACHED•SHEET
2, OWNER ~+ t°) r~~ MAILADDRESS ZIP PHONE
`'o f ``e ~.. ~ '
CONTRACT MAILADDRESS R,~ PHONE LICENSE NO.
4 USE OF BUILDING ~'~ ~~~m~~~~~
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~-,~ ~ ` , d
7. Sq. Footage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ ~;~ ,. ~ r~
laln: Floodway Yes® No ® Dev. Permit
10
FIOOd Elev. Cert.
p
.
Fringe Yes^ No ^ BFE
11. Current Zoning: Site Plan Attached Complete Plans Attached
~ ~~ ~
12. State Fire Marshall Required: Yes ^ No^ ~ jf
Approximate Com letion Date T- %
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 ~' ~1 Side ~ Rear~~ septic Remote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building
~
APPLICA N ACC TED BY H F5p B ~
~ PR D F ~ Footings Drywall
~
~~~~ ~
~ ~ f
~ (before finish)
~ . l _- ,
~ NOTICE ice' %~ Framing ~ Final ~°l ~~~~
Separate permits are required for electrical, plumbing, heating, ve ilating an air dondi-
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'.
I hereby agree to perform the proposed work in accordance with the specifications set forth Final Temporary Service
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) MechanlCal
months or longer, whichever is earliest.
Rough-in
ABC
SIG RE OF ER/CONTRACTOR OR AUTH ENT DATE Final
Plumbing
.r ~ Ground Work
SIGNAT E OF OWNER (IF O NER BUILDER) DATE ROUgh-In Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRIG: Blalr, NE Rev. Ofl/BS
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