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BP7814i I ~~ ~, ~UIL®ING PERMIT APPLICATION I~ it Fee: ~/~~ ©~ Jurisdiction of City of Blair, Nebraska 218 South 16th Street nuance Fee: Blair, Nebraska 68008 )eposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit 7 8,- 4 application Date: ~_~^~j ~ JOB ADDRESS / // ~ / / / ~J Issue Date: LEGAL LOT NO. BLK. 1 TRACT . DESCR. ^ SEE ATTACHED SHEET OWNER - 'Z, ~ ~ 1~~. ~ / MAIL ADDRESS ~,//~ c ZIP PHOpN/E~ 3. COf~T{iACTOJ/. R /7~ ~ MAIL ADDRESS ,(~ ~~ 1"",^~-,_~~~, `/~,1(J ~ 7/~ /IY~r. ~~ Zlp PHONE l ~~ off. 4. Class of Work: D NEW O ADDITION O REMODEL 5. Describe Work: ~ O Finished Basement O Unfinished Basement ~ .~~ 6. Total Sq. Footage (IRCIudiRg Basement and Garage): Total Fini shed Area; 7. Valuation of Work: $ / p ~ , ~ ~ Floodway O Yes O No 8. Floodplain: Dev. Permit 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 13. Minimum Setbacks: Front 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 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 thatconstruction covered by this permit application shall not be commenced until I have received a copy ofthis application form signed by the 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 da or isis not within 2 years of to of issue. 7-~~~~ iIGN URE OF OWNER/CONTR CTOR DATE Comment: O Site Plan Attached ~omple~ Pins Attached Approximate Completion Date / Inspections Required. and Fees Utilities Sewer Septic Buildina Footings Framing Electrical Rough-in Final Temporary Service Mechanical Rough-in Final Plumbinu . Ground Work Rough-in AIC Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Ap ved By: Water Service Remote Stop Box Card Drywall (before finish) Final _ ~ ~~ 7r~~ Fixtures Permanent Service POUNDS PRTG: Blair, NE Rev. 8/96 BUILDING INSPECTION REPORT r._: } ":~ - CTI'Y OF BLAIIt ^~ WASHINGTON COUNTY ^ OTHER - LOCATION OF INSPECTION: ~~' ~ ~~ "'n-`'~~ I~ --NAME OFOWNER: ~ ?~~ j~~ ~~"j'Z'-~'~l' CONTRACTOR: ~ 1 ~ ;~-+~ ~'~'~•'-~ .. _ -T ~ ~- " ~: DATE INSPECTION REQUESTED: PERMIT N0: i_ TIME INSPECTION REQUESTED: TYPE OF INSPECTION REQUESTED: ~..p~ BUILDING: ~ - I ^ FOOTING ^ FRAMING ^ DRYWALL ~AL UTILITIES• ^ SEWER TAF ^ SEWER ^ SEPTIC ^.WATER TAP ^ REMOTE ^ WATER SERVICE ~4 ,. ELECTRICAL: ' ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS PERMANINT SERVICE ^ TEMPORARY SERVICE ' MECHANICAL: I' ^ ROUGH IN ^ A/C ^ FINAL i PLUMBING: 1. ^ GROUNDWORK ^ ROUGH-IN ^ FINAL RESULTS OF THEINSPECTION: ' ASSED ~s~rio~rES~ NOTES/REMARKS: