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BP7052
BUILDING PERMITAPPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 CATION Permit ~~~~ Application Date: ~'~~f~~l~ Issue Date: ~i `(`T' ~~ Permit Fee: $ ~' ~-~1 JOB ADDRESS ~ 4 ~ 611~Je ~ ~ ~(r- LEGAL 1 LOT N0. BLK. TRACT ^ SEE ATTACHED SHEET ' DESCR. OWNER 2. i S Z MAILADDRESS -~, fig IP PHONE L)C~~' o r v~ L C NTRAC 0 i 3' ~i MAI DDRESS r PHONE LICENSE N0. ' zf2 -z~ ~~ ( ' n ~ r1ni5 oo J?arm 1 9 ; ~~2 Ji o~ 4. USE OF BUILDING 5. Class of Work: EW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: ~ . ~ r1 ~~ ~ ~ r" 7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ _ l ~ © ~ No ^ lain: Flooaway Yes ^ 10 Flood Dev. Permit Elev Cert . p Fringe Yes^ No ^ . . BFE 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 1 APPROVED FOR ISSUANCE BY NOTICE Separate permits are required for electrical, plumbing, healing, ventilating and air condi- tioning, and septic systems. ey 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 Cily of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within 180 days, is not comgl¢ted within 2 years ofjhe date of issuance, or if work is abandoned for six (8) Site Plan Attached ^ Complete Plans Attached ^ Approximate Completion Date ~ ~' ~ ` Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote Building Footings Drywall (before finish) Framing Final ~ ~~/2~``~C(~ Electrical Rough-in Permanent Service Final Temporary Service mon'h~p 'c rjr~s~ r~ ~iT~~~ SIGNATURE OF OWNERfCO RACTOR OR AUTHORIZED AGENT DATE SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Mechanical Rough-in ABC Final Plumbing Ground Work Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS Y UR PERMIT Comment: Approved By: ~ - L~L~~ POUNDS PRTG: Bletr, NE ~ ~ Rev. 08/85 5~~ING INSPECTION REPORT