BP7002J08ADDRESS ~
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LEGAL LOT NO. _ BLK. TRACT
1' DESCR. ®SEE ATTACHED SHEET
OWNER MAIL ADDRESS ZIP PHONE
3 CONTRACTOR G MAILADDRESS PHONE LICENSE NO.
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4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
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6, Describe Work: j - ~" _ - ~ ~ ~ ~~
I7, $q.FOOtageofStrUCture(IncludingBasementandGarage): ~~~~ .,~.: ;~ e -~._
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$, Change of Use From:
change of Use To:
g, Valuation of Work: $ ~~,~ ,
I1Q Floodplain: Floodway Yes^ No ^ Dev.Permit
Fringe Yes^ No ^ BFE
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
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separaf 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 not constitute issuance of this building permit. I further
agree that construction govered by this permit application shall not be commenced until I
have received a copyof this application form signed by the Building Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications sei 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 cgmpleted within 2 years of the date of issuance, or if work is abandoned for six (8)
months or longer, whichever is earliest.
SIGNATURE OF OWNER/CONTRACTb'Fi,~FtA„IDm®UTHgAI'-ED AGENT DATE
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BUILDER) DATE
SI~NOF OWNER (IF OWNE y~4~
Elev. Cert.
Site Plan Attached ^ Co lete Plans Attached ^
Approximate Completion Date t
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Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~~~ °~.a~~f~~,r~
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~~
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POUNDS PRTG: BIaV, NE ~ Rev. Ofl/BS
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[~`ciTY o~ RLAIx ; ~ wasl~iGTON coUNTY _.. ,,
^ OTHER ~ .
LOCATION OF INSPECTION:' `~-~ ~~ '~ °~``~~°~ '"
NAME OF OWNER: °-j~' .°.~-S .-,'%,_~-
,rte CONTRACTOR ,-` ,~ `~ y 4 -'
DATE INSPECTION REQUESTED: PERMITNO: --r`~~~-~---~ ,
TIME INSPECTION REQUESTED: j
TYPE OF INSPECTI,ON REQUESTED `~'`
BUILDING: ~ - '
OFOOTING ~ FRAMING ;DRYWALL ];'FINAL { `G•r~"~ ~ ~-~,
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MECHANICAL: ~ °- '
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I- Q:ROUGH-IN Q A/C ^ FINAL
~ ,:: 'PLUMBING:
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° ~' ~ GROUNDWORK ^ ROUGH-IN , ~ FINAL
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DATE OF INSPECTION MADE ~ ~ ~ ~~ TIME. ~ ~ '
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. ° ~ CALLED ORPll\ TO CONNECT SERVICE: ° ^ XES Q NO
. WANT. OFFICE STAFF TO GALL OPPD\ - 0 YES ^ NO BLR 1
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