Job DescriptionCITY OF BLAIR BUILDING PERMIT APPLICATION
218 S 16T" St, Blair, NE 68008
Office: (402) 426-4191 Fax: (402) 426-4195
building@blairnebrasl<a.org
JOB ADDRESS: PID - 890089126 Washington County, Ne
LEGAL: Sec 10, Township 18NjfAe 11E Lot:
214
Block:
HOMEOWNER: omas unning
CURRENT ADDRESS: 13342 Hwy 91
CITY. Blair STATE: Ne ZIP: PHONE NUMBER: 402-916-0187
NTRACTORS
GENERAL CONTRACTOR: Blackhawk Construction LLC �-----
ADDRESS: 973 CR 47 CITY: Tekarnah STATE: NE zip: 68061
PHONE: 402-889-7852 FAX: CELL:
EMAIL: dave@blackhawkconst corn
ELECTRICAL: PHONE:
MECHANICAL: PHONE:
PLUMBING: PHONE:
SEPTIC: PHONE:
PROJECT DESCRIPTION (Circle One)
NEW RESIDENCE < ADDITION REMODEL ACCESSORY DECK POOL GRAIN BIN
DISTANCE BUILDING WILL BE FROM PROPERTY LINES
FRONT P.L. OR CENTER LINE OF ROAD: 869.4 REAR: SIDE: 60.5 SIDE: 111.2
BUILDING DETAILS
NO, OF FLOORS: 1
NO, OF BEDROOMS:
3
NO, OF GARAGE BAYS: 3
DISPOSAL: Y
OVERSIZE TUB (>50 GALS): N
SQUAREFOOTAGE
1st FLOOR: 1976
end FLOOR: 0
3rd FLOOR: 0
FINISHED BASEMENT: N
UNFINISHED BASEMENT: 1976
FINISHED ACCESSORY:
UNFINISHED ACCESSORY:
DECK/PATIO/PORCH(S) (Total of all): 357
GARAGE: 876
GRAIN BIN DIAMETER:
APPROXIMATELY CONSTRUCTION START DATE: May 25, 2023 _END DATE: February 28, 2024
The above requested information is, to the best of my knowledge, true and accurate. It is understood and agreed that any error, misstatement or
misrepresentation of fact, either with or without Intention on my part, such as might if known, cause a refusal of this application or any alteration or
change in plans made without the approval of the City of Blair Building Department, subsequentto the issuance of the building permit shall constitute
sufficient grounds for the revocation of such permits.
By this signature, t City of Blair Building Department, is authorized to enter upon the property described for the purpose of Inspections,
SIGNED: 3.� DATE: 5/19/2023
(Note: We will not accept the application, If all required documents are not provided at the time of submittal.)