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BP7363a~~, BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska Permit Fee:~~D b 218 South 16th Street Issuance Fee: Blair, Nebraska 68008 7 3 6 3 Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit Application Date: ~` g' g ~ Issue Date: ~ ~ JOB ADDRESS /5 ~~ ~ LEGAL 1 . DESCR. LOT N0. BLK. TRACT ^ SEE ATTACHED SHEET 2.OWNER/ /~~ ~ / ~I~ DRESS 6 ZIP ~~`~~ g~HONE J MAIL ADDRESS CDNTRACTDR 3. PHONE ZIP 4. Class of Work: NEW O ADDITION O REMODEL 5. Describe Work: O Finished Basement O Unfinished Basement 6. Total Sq. Footage (InDluding easement and Garage>: Total Finished Area: 7. Valuation of Work: $ Q p r © a Floodway O Yes O No Dev. Permit 8. Floodplain: Fringe O Yes O No 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 J 13. Minimum Setbacks: Front ,/~ Side .~._ Ream 14. Sidewalk Required: O Yes O No Waiver Approved NOTICE Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic systems, By my signature below, I acknowledge chat 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. 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. X /~/~~z~~ 9- 9 - 9l0 SIGNATURE OFOWNER/CONTRACTOR DATE Comment: Site Plan Attached O omplete Plans Attached Approximate Completion Date ll ~` ~~ Inspections Required and Fees Utilities Sewer Septic Building Footings Framing Electrical Rough-in Final Temporary Service Mechanical Rough-in _ Final Plumbing - Ground Work Rough-in WHEN PROPERLY V. roved By: /, Water Service Remote Stop Box Card Drywall (before finish) Final ~' Z~~(a Fixtures Permanent Service A\C Final THIS SPgCI~J-TH IS YOUR PERMIT ~ Rav. 8/96 POUNDS PRTG: Blair. NE CITY OF BLAIR Application for Building Permit PLOT PLAN I Address '~ ~ ~ Date ~^ 1' r ~~ Legal Description: Lot Block Addition Please show all measurements of existing and contemplated structures, also show distances between structures, etc., and property lines. Is this a corner lot? _ '%~~ v .,~ a a 0 '' Pro ert Line y~,~y~ " ~-<-~ ~ ~/ ~1~~ ~~~ ~~~ ~ o~ ~~? N Indicate North _ _Center Line_of _ _ _ Street_ _ Applicant - - . : , BUILDING I1~TSPECTI0N .R EP®RT L''~CTI'Y OF BLAIR ~ WASI~NGTON COUNTY '~ ~ OTHER >'LOCATION OF WSPECTI Ar: ~ ~ _ cam" NAME OF OWNER: .~~ - CO CTOR: DATE WSPECTIONREQUESTED: PERMIT N0: TIME WSPECTIONREQUESTED: - TYPE OF INSPECTION REQUESTED; BUILDING: - ^ FOOTWG ^ FRAMWG ^ DRYWALL. ' UTILITIES; SEWER TAP ~ SEWS ~ SEPTIC I ~ WATER TAP . ^ REMOTE ^ WATER SERVICE ~ ELECTRICAL: O ROUGH W ~ FIXTURES a SAL .MOTORS PERMANENT SER VICE } l - D TEMPORARY SERVICE MECHANICAL: - ROUGH-W ~ ,a,~C ~ SAL .. PLUMBING: _ ^ GROUNDWp~{ `LROUGH-W ^ FINAL