BP6975f ~~~~~ ~ BUILDIIVCa PERIUIITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
402) 426-4191
CATION
Permit
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Application Date: Issue Date: c~~-t-'r5~ Permit Fee: $ .~a -
JOB ADDRESS , ^~ f~ ~ ~
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LEGAL
1 LOT NO. BL TRACT
^ SEE ATTACHEDSHEET
. DESCR.
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2
` MA~LAD O S~ ZIP O PHONE
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CONTRACT ILADDRESS 6 ~ PHONE LICENSE NO.
3
/ l~1 /1 ( L>U I l~ /~ ~ ron
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ` ~ _ ~. ~ ~ ..e y~
7. Sq. FOOtage Of StrUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~
FIOOd Ialn: Floodway Yes ^
10
p No ^ Dev. Permit Elev
Cert.
.
Fringe Yes^ No ^ .
BFE
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~ •-
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ Utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^ Sewer Water Service
15. Minimum Setbacks: Front Side Rear septic Remote
16. Sidewalk Required: Yes^ No ^ Waiver Approved Building
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
y 7
~
NOTICE F
i Final ~ ~ ~'
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ram
ng
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
Electrical
building permit application fee does not constitute issuance of this building permit. I further
agree that construciion covered by this permit application shall not be commenced until I
have receivedacopyofihisapplicationformsignedbylheBuildinglnspectorandstamped Rough-in Permanent Service
'APPROVED'.
Iherebyagreetoperformiheproposedworkinaccordancewiththespecificationssetforth Final Tem ora Service
p ry
above and in accordance with the codes/ordinances of the City of Blair and the Staie of
Nebraska. I understand that this permit is void if work is not commenced within 180 days,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (6) Mechanical
months or longer, whichever is earliest. Rough-In ABC
SIGNATUR FOWNER~CONTRACTO UTHORIZEDAGENT DATE Final
-~ ~ Plumbing
Ground Work
SIGNATURE OF OWNER (IF 0 ER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~ A
~1INnC PRT(; ~Rlnlr_ NF C/ Rte'