BP7146BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Framing
716
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Application Date: ~` / ` ~~ Issue Date: Permit Fee: $ / p
JOB ADDRESS ~ ~ /~ ' / ~ .-~
DU
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ MAILADDRESS O N ;IPA /~ ~
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HO
NE
r3 CONTRACTOR MAIL DDRESS ,. LICENSE NO.
4, USE OF BUILDING
5. Class of Work: ^ NEW ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ s ~ ~ " h~~
], Sq. FOOtage Of StrUCtUre (Including Basement and arage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ GI ~ ~~ ~
10 Floodplain: Floodway Yes^ No ^ Dev. Permit Elev. Cert.
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
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)
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'.
hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codes/ordinances of the Ciry 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)
~moNhl~~oJtg~r, hi~ver is I' ~~,P ,r-~_rl' ~o
ShU ^~~/R€/OAF 0~ WNER)CONTRACTOR OR AUTHO ED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
CATION
Permit
Final f ~ `~~~
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: '
~~~
POUNDS PRTO: elalr, NE Rev. 08185
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