BP7891BUILDING PERMIT APPLICI~TION
Jurisdiction of City of Blair, Nebraska
f~ermit Fee: 218 South-16th Street
Issuance. Fee: ~~~ ~ ~ 53 ~ ~ Blair, Nebraska 68008
Qepo~i# Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit-
Application Date: ~ " ~ `~ ~ Issue Date:
JOB ADDRESS /~ , /~ \~y, ~ Cr~~ a/
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LEGAL
1. DESCR. LOT No. B
LK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~~ MAIL ADDRESS /~ ~~ ZIP ~ PH NE
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S. CONT TDR /~ }
~/ -~r`S J?S.~n~ ' /
~ I~ ~` ~ PHONE
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4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: /llil ~~'L9~~~ O Finished Basement O Unfinished Basement
6. Total Sq. Dotage pRl;md~R9 BasemeRr ana Garage): Total Finished Area:
7. Valuation of Work: $ ~~~~ ~ d ~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes O No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: O Yes O No Waiver Approved .
NOTICE
Separate permits are rettuited for electrical, plumbing, heating, ventilating and air
conditioning, 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 copyof this application form signed bythe Building
Inspector.
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 yea f date of issue.
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SIGNATURE OFOWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached O Complete Plans Attached
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Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
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Framin Final
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Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbin
Ground Work
Rough-in
A\C
Final
WHEN PROPERLY VALIDATED (IN THIS S
THIS IS YOUR PERMIT
7991
POUNDS PRTG: Blair, NE Rev. B/98
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