BP7760JOB ADDRESS
LEGAL
1 . DESCR. LOT N0. BLK. TRACT
®SE ATTACHED SHEET
OW
2. ER
i MAIL ADDRESS ZIP ,~ PHO
A TOR _
3. (
L ~
~ iL ADDRESS
~ ~ ZIP f HONE
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. .
4. Class of Work: O N
EW O ADDITION O REMODEL
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5. Describe Work: / .,~~ r k .~ ~ ,~ ~,.~,~, ®Finished Basement O Unfinished Basement
6. Total Sq. Footage (Including Basement and Garage): Total FInlShed Area:
~ c
7. Valuation of Work: $ ~ ~'
Floodway O Yes O No Dev. Permit
8
Floodplain:
Elev. Cert.
.
Fringe O Yes O No BFE
9. Current Zoning: O Site Plan Attached O Complete Plans Attached
Approximate Completion Date
10. State Fire Marshall Required: O Yes ®No
Inspections Required and Fees
11. Special Use Permit Required: ®Yes O No Utilities
12. Variance Required: O Yes O No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: ®Yes O No Waiver Approved Stop Box Card
Building
NOTICE 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
~' 9
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
commenceduntillhavereceivedacopyofthisapplicationformsignedbytheBuilding
I
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 City of Blair and the
State of Nebraska,lunderstandthatthispermitisvoidifworkisnotcommencedwithin Final Permanent Service
180 days or is not~ompleted within 2 year~~of date of issue.
' Temporary Service
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N
W Mechanical
SIG
AfiURE OF OW
CONTRACTOR ~ DATE
Rough-in A\C
Comment: Final
Plumbina
Ground Work
Rough-in
WHEN PROPERLY V
Approved By:
Final
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG.-Blait, NE Rev. fl/96
-~~_~-I-__- ~ __-~~ -----
~iT'Y OF BLAIIt ^ WASHINGTON COU; ~NTY ^ OTHER
LOCATIOI~OF INSPECTION: ~ ~ ~ ~`~ ~ ~' ~ ~~ ~~~ ~
_ ~
NAME OF OWNER: {'yi ~f~ 1~-~.5 °~rS` ~r~"Gt CONTRACTOR: ` ~ ' °~~ ~'~' ~
DATE INSPECTION REQUESTED: ~ ~~ ~ ~'` PERMIT N0:
,~.
TIME INSPECTION REQUESTED: ~~~ `'~
TYPE OF INSPECTION REQUESTED:
BUILDING: ~ ~
^ FOOTING ^ FRAMING ^ DRYWALL ~ FINAL
UTILITIES:
^SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
L ^ ROUGH-IN ^ A/C '~^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION:ASSED (s~rroTES) ^ FAILED (sue rro~rES) _'
NOTES/REMARKS:
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INSPECTOR: 7
'
~
s TIME:
DATE OF INSPE N MADE: ~y `` ~~ `~`
,
~"
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^NO
t WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO ,' BLR 1