BP7775)l -_ 1. _l ._l~aJ ~ '>i f ~,C ~_=Y aj /`\Ji3~, ,;~L~`L 91u~/'
'~ Jurisdiction of City of Blair, Nebraska
Permit Fee: c "..~' l.~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 ®Fax (402) 426-4195 P rmit
~` ~,
Application Date: Issue Date:
LEGAL LOT ND. BLK. TRACT
1. DES ®SEE ATTACHED SHEET
OWN M ADDRESS ZIP PHONE
2.
C CT R AIL ADDRESS PHONE
3..i'~ ~ >
4. Class of Work: ®NEW ®ADDITION
O REMODEL
5. Describe Work: / e ®~ ) ~ f1 O Finished Basement ®Unfinished Basement
6. Total Sq. FOOtage (Including Basement and Garage): -,~. Total Finished Area:
~~ ~~
7. Valuation of Work: $
Floodway O Yes O No Dev. Permii
8. Floodplaln: Fringe O Yes O No BFE Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: ®Yes
11. Special Use Permit Required: ®Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: ®Yes O N
® No
®No
Side Rear
o Waiver Approved .
N7'ICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
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
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 thatthis permit is void if workis not commenced within
180 days or is not completed within 2 years of date of issue.
TURE OF OWNER/CONTRACTOR DATE
Comment:
® Site Plan Attached O~Com~l fans Attached
~~
Approximate Completion Date ~
ff //r-
-,
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
Framin Final
g
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
A\C
Approved By: / f/~
POUNDS PRTG: Blair, NE Rav. 9/96
I
~~ ~~ --
[,~TI'Y fOF~FsI:A1R ^ WASHWGTONCOUNTY ^ OTHER
LOCATION OF INSPECTION: ~. 4~ ~/~ ~ ,~''/fi~ ~, ~,
NAME OFOWNER:~~f'ivCi~'~ ~=~{/,~?~ CONTRACTOR: ~ --=~~~
.DATE INSPECTION REQUESTED: PERMIT N0:
i
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING: 'l ~
^ FOOTING ^ FRAMING DR ~ ' ` ~ - t
^ YWALL [TAL ,
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL;
^ ROUGH-IN ^ A/C
' 1
^ ~~,
.
,` PLUMBING:
^ GROUNDWORK ^ ROUGH IN ^ FINAL
RESULTS OF THE INSPECTION: __ POSED ~s~ xo~s~ ^ FAILED ~s~ xo~rFS>
NOTES/REMARKS:
DATE OF INSPECTION MADE: ``- ~ ~ ~E: ;~ ~''
p
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ~ ^ YES ^ NO BLR 1