BP7906BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7906
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
�fo
Application Date: �� �'7 Issue Date:
JOB ADDRESS
/
LEGAL
1. DESCR.
LOT NO.
BLK.
TRACT
❑ SEE ATTACHED SHEET
OWNEILADDRESS
2.
CONT OR
3.
MAILADDRESS
Z / P
ZIP PHONE
4. Class of Work: O NEW O ADDITION
O REMODEL
5. Describe Work:
O Finished Basement O Unfinished Basement
6. Total Sq. Foota (Including Basement and Garage):
Total Finished Area:
7. Valuation of Work: $j3
Floodway Cl 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: 17 Yes O No
12. Variance Required: 0 Yes 0 No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: 0 Yes 0 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 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 o ' t completed ' hin 2 years of date of issue.
9`2
SI ATU E OF OWNERICONTRACTOR DATE
Comment:
O Site Plan Attached C}IC let Plans Attached
Approximate Completion Date d�
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough -in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough -in XC
Final
Plumbing _
Ground Work
Rough -in _
WHEN PROPERLY VALID (I
Approved By:
Final
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE k_r Rev. 8196