BP6832L
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6832
(402) 426-4191 Permit
Application Date: % U --Z 7-q � Issue Date: % (1 ' S� Permit Fee: $ f G G
d
J ADDRESS
1� (
Complete Plans Attached ❑
LEGAL
1' DESCR.
LOT NO.
BLK.
TRACT
❑ SEE ATTACHED SHEET
OWNER
l2.
ZIP PHONE
L1�_-t//7
. CONTRACTOR MAILADDRESS
3
PHONE LICENSE NO.
4. USE OF BUILDING
Remote
5. Class of Work: [j NEW ❑ ADDITION ED ALTERATION
❑ REPAIR ❑ MOVE ❑ REMOVE
6. Describe Work: �-
b,)u_U a (_ku
7, Sq. Footage of Structure (Including Basement and Garage): ."UvI ` 1L
L
Drywall
8, Change of Use From: Change of Use To:
9, Valuation of Work: $
Framing
10. Floodplain: Floodway Yes No ❑ Dev. Permit
Fringe Yes[] No ❑ BFE
Elev. Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ❑ NOD
13. Special Use Permit Required: Yes ❑ No ❑
14. Variance Required: Yes ❑ No ❑
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes E] No ❑ Waiver Approved _
IAPPLI TION ACCEP�� I PLANS CHECKED BY I 47ROVED FOR ISSUANCE I
/ 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 codeslordinances 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 qot plete within ears Vearl'
ate f issuance, or if work is abandoned for six (6)
Yn n b Ion r, ever is �s
l
IGNATURE OF 0 NER CONTRAC R OR AUTHMZED AGENT DATE
Site Plan Attached ❑
Complete Plans Attached ❑
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap
Water Tap
Sewer
Water Service
Septic
Remote
3-x-910- I Wog r.
Building
Footings �O ? �'
Drywall
(before finish)it ��
Framing
Final
Electrical
Rough -in
Permanent Service
Final
Temporary Service
Mechanical
Rough -in
ASC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough -in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS I YOUR PERMIT
Comment: I Approved By:
14
POUNDS PRTG: Blair, NE Rev. 08W
BUILDING Il SPECTION REPO -
r.��- RT
CII h OF BL 0 WASHINGTON COUNTY OT
HER
LiiOCATION OF INSPECTION:
NAME OF OWNER:I!(�i
CONTRACTOR: t iii
DATE INSPECTION REQUESTED: - /
PERMIT NO:
TIME INSPECTIONREQUESTED: F
TYPE OF INSPECTION REQUESTED:
t
BUILDING;
[] FOOTING D FKANIING il-DRYWALL [FINAL �� - � f� 1 ( _
UTILITIES Ej
' r
SEWER TAP []SEWER0 SEPTIC
i
D WATER TAP
D REMOTE- 0 WATER SERVICE )
ELECTRICAL;.
0 ROUGH IN ❑ FIXTURES 0 FINAL -
0 MOTORS
Ell PERMANENT SERVICE/C
DTEMPORARY SERVICE j
MECHANICAL: ccs"
r :l. D ROUGH -IN - f A/C
❑ FINAL
PLUMBING:`
i
D.GROUNDWORK 0 ROUGH -IN ❑FINAL
0 FAILED
�6�
TIME: >oC
TO CONNECT SERVICE:
❑" YES ❑ N0
WANT OFFICE STAFF TO CALL OPPD\
- _� 0 YES ❑ NO BLR 1