BP6971/.
- ~UIL~Ihi~ P~~NIITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
C~4T1®N
Permit
6~~~
Application Date: ~~~ ~ ' ~ ~ Issue Date: ~ ~~ I - 7 ~D Permit Fee: $ ~~ p~
JOB ADDRESS
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LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL ADDRESS
L c~ i 2 W SIP ~ ~
c Q / / ~ HONE U
`T ~o
CON RACTOR M
3.~G - ` n ~ DDRESS
`v. ~ v PHONE
(-f- 2(0-2 LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ['~ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE.
6. Describe Work: ~ d ~ ~ ~ U -~ ~-
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~, ~ ~, ~ (~ r ~ (~
10. Floodplain: Floodway Yes ^ No Q
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minimum Setbacks: Front -Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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 by the Building Inspectorand stamped
'APPROVED'.
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 1 SO days,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (fi)
months or longer, whichever is earliest.
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ ~~ -- ~ -g ~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
~~~~~~~
Framing Final
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
SIGN TURE OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF 0 NER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
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