BP7358Permit Fee: ' ,~~;~ _ ` ~ Jurisdiction of City of Slair, (Nebraska
218 South 16th Street
Issuance Fee: ~~ - ~ ~ Slair, Nebraska 68008
Deposit Receipt #: ~`> (402) 426-4191 ®I°ax (402) 426-4195 Permit
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Application Date: ~ ~ '~ Issue Date
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JOB ADDRESS
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LEGAL
1 . DESCR. LOT NO. BLK, TRACT
®SEE ATTACHED SHEET
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OWNER - MAIL ADDRESS
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MAIL ADDRESS ~
CONTRACTOR ")~~
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ZI ~ t PHONE
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4. Class of Work: ®NEW ®ADDITION ®REMODEL j / ~,~ ~~~~ -
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5. Describe Work: ,fi
~° R~ ~ ~ ®Finished Basement ®Unfinished Basement
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6. TOtal Sq. FOOtage (Including Basement and Garage): TOtal FInlShed Area:
7. Valuation of Work: $ ~ ' ~-' ~ ~ , C'~t''~
Floodway O Yes O No Dev. Permit
8
Flood
lain:
Elev. Cert.
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Fringe O Yes O No BFE
9. Current Zoning: ®Site Plan Attached ®Complete Plans Attached
Approximate Completion Date
10. State Fire Marshall Required; ®Yes ®No
Inspections Required and Fees
11. Special Use Permit Required: O Yes O No
Utilities
12. Variance Required: O Yes ®No Sewer Water Service
13. Minimum Setbacks; Front Side Rear
Septic
Remote
14. Sidewalk Required: O Yes O No Waiver Approved Stop Box Card
Building
N®'TICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning, and septic systems. By my signature below, I acknowledge that payment
of the building permit application fee does not constitute issuance of this building
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permit. I further agree that construction covered by this permit application shall not be
commenced until I have received a copy of this application form signed by the Building
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t Electrical
nspec
or.
I hereby agree to perform the proposed work in accordance with the specifications set Rough-in Fixtures
forth above and in accordance with the codes/ordinances of the Ciry of Blair and the
State ofNebraska.lunderstandthatthispermitisvoidifworkisnotcommencedwithin Final Permanent Service
i 80 days or is not completed within 2 years/ date of issue. Temporary Service
McCharllCal
SIGNATURE OF OWNERICONTRACTO / DATE
~~ Rough-in air.
Final
Comment:
Plu- mbina -
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (II
Approved By:
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. 8/96
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4 ` ,`CITY OF BLAIR ~ WASHINGTON COUNTY ~ OTHER
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' f. LOCATION OF INSPECTION: ~ ~'~ -a-' c°~'~~• .~ ,f,..%~'~ ,
- NAME OF OWNERS ,~~, . ~ ~~~° ~= CONTRACTOR: .~ ~
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DATE INSPECTION REQUESTED: PERMIT N0: ~ ~ ~-f "
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING:
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^ FOOTING ^ FRAMING ^ DRYWALL FINAL ~ ~
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~` UTILITIES:
~ ^ SEWER TAP ~ SEWER Q SEPTIC ^ WATER TAP
~` ^ REMOTE
~;• ^ WATER SERVICE
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ELECTRICAL:
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ROUGH W ^ FIXTURES ^ FINAL 0 MOTORS
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~` ^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
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PLUMBING: '
^ GROUNDWORK ^ ROUGH-W ^ FINAL
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RESULTS OF THE INSPECTION: ~ASSED ~sEExoTES> ^ FAILED ~sEExoTES>
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~ NOTES/REMARKS:
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