BP7400BUILDING PERMIT APPLI
~ , dC~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 ~ Fax (402) 426-4195
Permit
7400
Application Date: l " Z~ -~ ~ Issue Date: ~" ~ ~~
JOB ADDRESS ~ ~y ~ S • I ~ ~1
` ~ S~ ,
LEGAL
1 . DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~,., ^ _ „
~ (J~/ (.~-~~ ~ MAIL ADDRESS ZIP PHONE
CONTRACT R
3. .~ ns~-r~ ~aY1 MAIL ADDRESS
122 ~ fox ~ 4 ~ ZIP PHONE
~- - ce.,l.~')d1,~.vti., ~~oZ3 ~- ~fal .
O REMODEL
4. Class of Work: NEW O ADDITION
5. Describe Work: , ~_~
G~~=u` / O Finished Basement O Unfinished Basement
fiJ ~ Gii1
~. TOtal Sq. Footage (Including Basement and Ga
ra
ge): Total FInlShed Area:
//
l
7. Valuation of Work: $ 2r!p~ (~ ~ ~ V
Floodway O Yes fJ No
8. Floodplaln: Fringe O Yes O No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
O No
O No
Side Rear
14. Sidewalk Required: O Yes O No Waiver Approved
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septicsystems. 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 bythe Building
Inspector.
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 or is not completed within 2 years of date of issue.
L
OF OWNER/CONTRACTOR
Comment:
DATE
O Site Plan Attached Colnpl~ Plans Attached
O
Approximate Completion Date z
~
44
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
Framing (before finish) 9 ~i
Final 1c~- ~ ~` 7~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin _
Ground Work
Rough-in
Final
WHEN PROPERLY VALID D (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By; _
CATI®N
POUNDS PRTG: Blair. NE /~ Rev. 9/96
~. ELECTRICAL:
ROUGH IN ^ FIXTURES ^ FINAL ~ MOTORS
E,
0. FERMANENT SERVICE _
Q TEMPORARY SERVICE
• MECHANICAL:
ROUGH:W ~ A/C ^ FINAL .
PLUMBING:
GROUNDWORK
^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION:
. . PASSED (sEarroTES~ ^ FAILED (s~~rorES~
NOTES/REMARKS:
~,
_..