BP7139Application Date:
Blair, Nebraska 68008 ~' ~ k
(402) 426-4191 Permit ="
Issue Date: ~°~ ~"" ~ Permit Fee: $
JOB ADDRESS
LEGAL
1 LOT NO.
' BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR. ~
2. OWNER MAI ADDRESS Zlp PHONE
3 CONTRACT MAILADDRESS~ PHONE /1~ 9 LICENSENO}O/
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: .. ~
7, Sq. Footage of Structure (Including B9s9m9nt and GBrag9):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~' e~
10. Floodplain: Floodway Yes ^ No ^ Dev. Permit
F
i
Y
^ N Elev. Cert.
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nge
es
o ^ BFE
11. Current Zoning: Site Plan Attached ^ Complet ins Attaph~d®
Approximate Completion Date / ~~'
12. State Fire Marshall Required: Yes ^ No^
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
PLICATION ACCEPZED BY PLANS CHECKED BY ~-A ROVE F N - Y Footings Drywall
~ (before finish)
NOTICE 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
building permit application fee does not constitute issuance of this building permit. I further Electrical
agree chat construction covered by this permit application shall not be commenced until I
have receivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped Rough-in Permanent Service
'APPROVED'.
Iherebyagreetoperformtheproposedworkinaccordancewiththespecificationssetforth 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
o the o nger, wh' ever is a I' st. v,° -- Rough-in ABC
SIGNATURE OF NERfCONTRACTORORAUTHORIZEDAGENT DATE Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
c
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
Rev. 09195
POUNDS PRTG: Blair, NE
5 t