BP7365
Permit Fee: ~ ~~ ~~
Issuance Fee:
Deposit Receipt #: ~,
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 425-4191 ®I°ax (402) 426-4195 Permit-
~ ~~ __~~~. ~r
Application Date: ~~ ~ ~ Issue Date: -'
JOB ADDRESS _
~~
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LEGAL
1 . DESCR. LOT NO. BLK. TRACT
®SEE ATTACHED SHEET
OWNER }r/ ,jE I /,r ` -; M`~,4r1zL ADDRESS ZIP PHONE yy p'
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CONTRACTOR 1 MAIL ADDRESS
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ZIP
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PHONE
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4. Class of Work: O NEW ~ ADDITION REMODEL
5. Describe Work: ~~ ~~, ~` ~ ~ f~l d~~l>.r~.p-~-y ®Finished Basement ®Unfinished Basement
5. Tofal Sq. FOOtage (Including Basement and Garage): TOtal FInlShed Area:
7. Valuation of Work: $ 1 ~~) (, . (~~
Floodway O Yes O No Dev. Permit
laln:
8
FIOOd
Elev. Cert.
p
.
Fringe O Yes O No BFE
9. Current Zoning: ®Site Plan Attached ®Complete Plans Attached
Approximate Completion Date
i 0. State Fire Marshall Required: ®Yes ®No
Inspections Required and Fees
11. Special Use Permit Required: O Yes O No Utilities
12. Variance Required: ®Yes O No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: O Yes O No Waiver Approved Stop Box Card
Buildin
N071CE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning, and septic systems. Bymysignaturebelow,lacknowledgethatpayment ~ g~ ~~,
~~ ``
~
''
of the building permit application fee does not constitute issuance of this building Framing ,~
Final
~
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 Electrical
Inspector.
I hereby agree to perform the proposed work in accordance with the specifications set Rough-in Fixtures
forth above nd in accordance with the codes/ordinances of the City of Blair and the
State of Nebr ska. l understand thatthis permit isvoid if a is not commenced within Final Permanent Service
180 days or i not completed within 2 ears of date iss e.
1 ~~~~ ~~ Temporary Service
`~ Mechanical
DATE
SIGNATURE OF OWNER/CONTRACTOR Rouah-in ABC
Comment:
Final
Plumbing _
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDA
Approved By:
N THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. e/96
. - ~,~ DTI CT T
~, ~CTI`Y OE,,BLAIR ^ WASHINGTON COUN'T`Y ^ OTHER
1 ~ ~ ~,,.
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_ . ~ LOCATION OFINSPECTION: -~ r ~? y' `~ ~ ~ ~ ~ ~ ^•-~`'
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~: NAME OF OWNER ' 't ~ ~='t ` ~ r~"`` CONTRACTOR: ~'~'f ; ~{' ~.-~'~(°-._
~: }
~- DATE INSPECTION REQUESTED: '' (-~} ~ a 7f ~~<' PERMIT NO: --~ ~ ~=~ 1~
r
TIME INSPECTION REQUESTED: ~`~~ %~': ~--f ~'-': %'''ui
~' ~
TYPE OF INSPECTION REQUESTED: ~
BUILDING: ~ ., ~ ~
^ FOOTING ^ FRAMING ^ DRYWALL ~~ FINAL '
UTILITIES:
~..
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
j ^ REMOTE ^ WATER SERVICE
ELECTRICAL:
~,
;:
~` ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
~,
~' ^ PERMANENT SERVICE ^ TEMPORARY SERVICE •
I•
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
~' PLUMBING:
€r
k ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
is
~';
~;
I RESULTS OF THE INSPECTION: PASSED (s~rroTES> ^ FAILED (sue rrorES)
F:
€" NOTES/REMARKS:
~' -
~.
r;~-INSPECTO
... ~; ~
DATE OF INSPECTION MADE; ~" TIME`
E
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
s.
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1