BP7739
Permit 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
Application Date: ~ ~ ~ ~ Issue Date: `- ~ ~)
9. Current Zoning:
10. State Fire Marshall Required: ®Yes
11. Special Use Permit Required: ®Yes
12. Variance Required: O Yes ®No
® No
O No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: ®Yes O No Waiver Approved
N®TICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. By mysignature below, I acknowledge that payment
of the 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 have received a copy of this application form signed bythe Building
Inspector.
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 Nebraska. I understand that this permit is void if work is not commenced within
180 ys is not completed within 2 years of date of issue.
.~_
GNATURE OF OWNER/CONTRACTOR DATE
Comment:
®Site Plan Atiached ®Co plate Plans Attached
Approximate Completion Date ~ `~ ~~°-~ - ~
Inspections Required and Fees
Utilities
Sewer
Septic
Buildina
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
Final
Plumbin _
Ground Work
Rough-in _
Final
WHEN PROPERLY V
Approved By:
f
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final
Fixtures
Permanent Service
A\C
rI ~~ ~,
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE _ ~ Rev. 6/96
CITYOR,B~;AIR~ ^ WASHINGTONCOUNTY ^ OTHER
~ /~ ~
` LOCATIONOFINSPECTI N: ~` ~ ~~~
NAME OF OWNER ~ ~~~'` ~ CONTRACTOR:. fFCe.3t-'L .
DATE INSPECTION REQUESTED: ~`'~ ~`'~~ .~ t~ PERMIT N0: ~ '
t~~`
TIME INSPECTION REQUESTED: ~°" ~
TYPE OF INSPECTION REQUESTED:
_,,_
BUILDING: ..
,~ rte'-
^FOOTING ^ FRAMING ^ DRYWALL ~~INAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS '
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHAMCAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
,~_r>.
RESULTS OF THE INSPECTION: ASSEA (s~xo~rss) ^ FAILED (s~xo~rFS)
NOTES/REMARKS:
2, ~~ ~ ~`'
DATE OF INSPECTION MADE: ~ ~~~~ ^~`~ ,.~ TIME: u~ ^ '`,
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO r`
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1