BP7242JOB ADDRESS
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SEE ATTACHED SHEET
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DESCR. / ,r
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2. OWNE MALADDRESS ZIP PH NE / `~/
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3. CONTRACTOR MAILADDRESS PHONE ~~~„~ ~~~~~
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4. USE OF BUILDING
5. Class of Work: EW ^ ADDITION ^ ALTERATION ®REPAIR ^ REMOVE
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6. Describe Work: ,rl~ri? ~~ - /% ~ `, ~ f , ; ~; , n ~ ,11 } l7 ~~ -
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7. Sq. FOOtage Of StrUCttgre (Including Basement and Garage): ~ ~~"~ tJ ~ ~~`~~~
$, Change of Use From:
Change of Use To:
g, Valuation of Work: $ -~ ~; ~~Ca "~
Floodway Yes^ No ^ Dev.Permit
10. Floodplain: Fringe Yes^ No ^ BFE EIev.Cert.
11. Current Zoning: Site Plan Attached ^ Complet~~~ns;~~ ched ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~~'' ~~
Inspecti®ns 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 I Building
PP ATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings ~~ Drywall
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` (before finish)
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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 permitapplication 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 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
months ortonger, whichever is earliest. Rough-in ABC
SIGNATURE OF OWNER~CONTRACTOR OR AUT ORIZED AGENT DATE Final
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~`,'~~~ "~ r~ ., Plumbing
~ , ~ ~~,,'- ~ `~' t~~ ~' Ground Work
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SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS Y®UR PERMIT
Comment: p~proved By:
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POUNDS PRTG: Blair, NE Rev. 0&/95
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CITY OF BLAIR
Application for Building Permit
PLOT PLAN
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Address _~ ~' ~;' ~~` ~ Date ~
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Legal Description: Lot L to _ J1 ~ Block Additio~ ~ ~
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot?~ ~
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Indicate North
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Applicant ~J(~~,~!~ ~~~U. -~'~~ ~ ~t~;
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