BP7103~~ - BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
713
Application Date: ~` Z" l (~ Issue Date: ~ ' Z~ ~ ~ Permit Fee: $ ~ ~ ~~
JOB ADDRESS
LEGAL
1' DESCR. LOT NO. BLK. TRACT
^ SEEATTACHEDSHEET
2 OWNER 1 /u /~r~ ~ // r n ~ e~.
i/ /`~ AIL D RESS ZIP
~ ~ ~//J~ e 4~ PHONE
3. CONTRACTOR
~~!VI'1'1~-- MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR MOVE ^ REMOVE.
^
6. Describe Work: ~~~~ - ~ ~~~~- ~G'~^~~?.~~ ~- [~
G~t.~' ~ 1
], Sq. FOOtage Of StrUCtUr@ (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ U~, ~
Floodway Yes ^ No ^
10. Floodplain: Fringe Yes^ No ^ Dev. Permit
BFE
EIev.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 _
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 notconstitute 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 180 days,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (8)
months or longer, whichever is earliest.
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date _~ ~ ~' ~~~
Inspections Required and Fees
Utilities i
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish)
Framing Final ti/ ~'3~~0
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
SIGN TU OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE Final
J~~~„ • .'_ - t Plumbing
}~cit~. k~r~QO" Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ROUgh-In Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) TFJIS IS YOUR PERMIT
Comment: I Approved By: ~ ' /~
`~ /i1.1 n ~/L
CATION
POUNDS PRTO: Blair, NE / Rev. 08/85
~`
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