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BP7088" ~ BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 7 (~ (402) 426-4191 Permit Application Date: SJ~ -I -~~,o Issue Date: ~-~ ~ -~(r, Permit Fee: $ 5~~- JOB ADDRESS ~ c ,c~ ~ c_ e~ ~cir C~ LEGAL 1 LOT NO. BLK. TRACT ^ SEEATTACHEDSHEET ' DESCR. 2. O NER ~ MA L ADD ESS ~ ~ ZIP ~ HONE ~ONATRAC OR 3. v ` MAIL ADD SS ~ PHONE LICEN_ SE N0. I `~ ~ ~ © o ~ u v~ ~ ~ ~. ~ l 4. USE OF BUILDING 5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: ~ J 7. Sq. Footage of Structure (Ind ding Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ 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 8Y 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 applicaiion fee does not constitute issuance of this building permit. I further agree that construction covered by this permit applicaiion 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, Site Plan Attached ^ Complete Plans Attached ^ Approximate Completion Date ~ - 3 ~ ~~/ ~ Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote Building Footings Drywall Framin (before finish) Final ,f~' ~~~'~ ~ g Electrical Rough•in Permanent Service Final Temporary Service Is not completed wlthm 2 years of the date of Issuance, or If work Is abandoned for slx (8) Mechanical months or longer, whichever is earliest. Rough-In ABC SIGNATURE OF WNER~CONTRACTOR OR AUTHORIZED AGENT DATE Final Plumbing Ground Work SIG REOFOWNER(IF NER BUILDER) DATE Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: 'OUNDS PRT6: BIeI~. NE ~ RB~• oaf ~~ ~ ~ _ BU ~~~ G INSPECTION REPOI~,T ---_- ---1~' ~ . y -~ ' . n - ~ ~. ~~TI'Y OF BLAIIt ^ WASHINGTON COUNTY ~• ^ OTHER ~ j . . LOCATIONOFINSPECTION;- ~ ~ /~-f~~~~'~'-S NAME QF OWNER. _~:; ~?rZ~ ~-:,~ ;~ `ems'- = CONTRACTOR: fir= `~'~r7 J -~ DATE INSPECTION REQUESTED: ~ 1 PERMIT N0: ~=~~ y j ! 'TIME INSPECTION REQUESTED: ' _. > ~ TYPE OF~INSPECTION REQUESTED: . l: BUILDING ~ -i FOOTING ~~ ^ FRAMING :^ DRYWALL [FINAL ...--- ~''t .~,~ ~ I .. UTILITIES _ =~ .:, S$WERfiAP ,~_^ SEWER . ^ SEPTIC ~~ , - ^ WATER TAP REMOTE ^ WATER SERVICE _ .ELECTRICAL , '., _ ROUGFI IN • ^ FIX'T'URES - ^ FINAL ^ MOTOR$ ~ - PERTv1ANINT _SERVICE ^ TEMPORARY. -: SERVICE - , ~ MECHANICAL..=' ~ ~ .. ~ _ ~ _ ~.._ -= ROUGH IN ~ ~ A/C ^ .FINAL ,.. _ ., PLiJMBIIVG ... ~. ^GRO.UNDWQRK . ~ ^ROU~H-IN' .: ,. _ .. ,. .: ~" ^ FINAL _.. ,. ~._ -- -