BP7060JOB ADDRESS ~~ \
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LEGAL
1 LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
2. OW ER MAILAD RESS ZIP / (`~ PHONE
CONTRACTQR _ MAIL DRESS
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A
~ PHONE LICENSE NO.
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USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ ~ ~,~ C _ ~. ~ j ,e f
], Sq. Footage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ '~ ~ ~~C`~ r r~cj
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No ® Dev. Permit
lain: Floodwey Yeses
10
Flood Elev. Cert.
.
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Fringe Yes® No ^ BFE
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date .~ ' %~ C~ ~`~ (~
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 APPROVE6 FOR ISSUANCE BY Footings Drywall
(before finish)
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N®TICE Framing Final ~ °~~ ~-~'
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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 chat 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 comp) within 2 years of t e a f iss ance, or if work is abandoned f r six (ti) Mechanical
months g r, whichever is ~ ~~ ~Y~>.- Rough-In ABC
SIGNATURE OF OWNERfCON ACTOR 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
:,omment: Approved By:
II INf1C PRTf:.Rlalr NF Rev. ~
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