BP6415ice';
i
Permit
r ~~
Permit Fee: $
JOB ADDRESS ~ p ~'~i~ ~ ~~"'~~ ~ ~.
r~1 lll~`Ir ~ .
LEGAL
1 ' DESCR. LOT N0.
~. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL ADDRESS
. ZIP PHONE
~~''~ ~~
3. CONTRACTOR - ~ AILADDRESS
c,`(XI , + PHONE LICENSE NO.
`t ~ i ~ ~~ 1~
USE OF BUILDING F
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR MOVE ^ REMOVE
6. Describe Work:
]. Sq. Footage of Structur (Including Basement and Garage): ( _
~ ~ ~ ~~ ~
$, Change of Use From: ~ u ~ ~ r ` ~ ~ r ~ Change of Use To:
g, Valuation of Work: $ ~t~b
10. Floodplaln: Floodway Yes ^ No ^ Dev. Permit
^
EIev.Cert.
Fringe Yes
No ^ BFE
11. Current Zoning: Site Plan Attached ® Complete Plans Attached ^
State Fire Marshall Required: Yes ^ No^
12 Approximate Completion Date
. Inspections Required and Fees
Special Use Permit Required: Yes ^ No ^
13 Utilities
. Sewer Tap Water Tap
14. Variance Required: Yes ® No ® Sewer Water Service
15. Minimum Setbacks: Front Side Rear Septic Remote
E
16. Sidewalk Required: Yes^ No ^ Waiver Approved ~ -. Fy!
Building ,~..~ t> - ~ ,.
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
v ~ ~ ~ ~~
~
NOTICE Framing Final
`~
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the ElectrlCal
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I Rough-In Fixtures
have received a copy of this application form signed by the Building Inspector and stamped
'APPROVED'. Final Permanent Service
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not ompleted within 2 y ars of date of issue. Mechanical
~~t ~ ~~ `~ ~C%~5
1~ '~ ~~r .~ Rough-in ABC
~
SIGNATURE OF OWNERfCONTRACTOR 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
Comment: Approve By: ^
POUNDS PRTG: BIaIr, NE Rev. 10/91
- d r_.
. ~ '~
` [~CTIY OE BLAIR ^^ WASHINGTON COUNTY ^ OTHER
-~
'' LQCATION OF INSPECTION: ~ • ~~ ~ I'
NAMEOF OWNER: CC:NTRACTOR: ~ ~ ''~f~~
DATE INSPECTION REQUESTED: ~~ C(. ~~ PERMIT N0: `~ ~~
TIME INSPECTION REQUESTED: ~l
1
TYPE OF INSPECTION REQUESTED:
- BUILDING: __ ~ I
~/• ~~ ~ ~
^ FOOTING ^ FRAMING ^ DRYWALL FINAL 1
UTILITIES:
__. ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
~ ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
i
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
i
^ ROUGH-IN ^ A/C ^ FINAL ~
i
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
i
RESULTS OF THE INSPECTION: ~~PASSED (sEExoTES) ^ FAILED (sEExoTSS)
NOTES/REMARKS:
'I
- INSPE
G
DATE OF INSPECTION MADE: ~~ 'TIME:
C9LLED OPPD\ ` TO CONNECT SERVICE:. ^ YES ; ^'NO ``"
_;- _1
,_ ,
WANT OFFICESTAF~ TO CALL OPPD\ ^ .YES ^ NO •; BLR 1