BP7059?f3
Application Date: "~~~' ~ Issue Date: °~- ~ Permit Fee: $ ,`~,~ ~ ~--
JOB ADDRESS 1
LEGAL
1 LOT NO. BLK. TRACT
^ SEEM IACHEDSHEET
' DESCR.
OWN j~
2. ~~ c~ ,r yr ~ ~ I~ cr ~ MAIL ADDRESS
e r' ~' . 2_ ~~ ZIP
~? C~ PHONE
2 6 `~ Z ~ ~
_ MAIL ADDRESS
CONTRA TOR
~ ~
PHONE
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LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ®REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ ~`~ ~ c ,- ~ ~°~- -~, ce u" ~ .- U.~ ~ ~~
], Sq. Footage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ , ~~ ;~ p `~ ~ ~ (~ ¢ ~ ~
Floodway Yes® No ~m Dev.Permit
10. Floodplain: F
i
^
Elev. Cert.
r
nge Yes
No ^ BFE
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~? ~-.~ b ~~~ ~
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 BY PLANS CHECKED 8Y 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 not constitute 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 Tem ora Service
p ry
above and in accordance with the codes/ordinances of the City of Blair and the State of
Nebraska. I un erstand that this permit is void if work is not commenced within 180 days,
is not comp) d within 2 years of th da f issuance, or if work is abandoned for six (8) Mechanical
wont s ger, whever i i Rough-in ABC
SIG ATURE OF OWNER~CO RACTOR OR AUTHORIZED AGENT DATE Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ,d~'
s _ y w - ..
..,~ ~.~~~ DoT.- o~..~..~o °~ Rev. Oe/9: