BP13482Application for Perm Fee $40 + Issuance Fee $25 + $50 Deposit Fee: $115.00
Egress Window (floor plan drawing required)
Fences (plot plan required)
Gazebos (plot plan required)
Patios /Driveways /Sidewalks (new or replacement)
Roof ing/Siding/Soffit and /or Eave Repair /Gutters
Swimming Pools with Fence (plot plan required)
Window /Door Replacement (size change only)
Miscellaneous Building Permits (items not covered by one of the above)
Description:
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Lin. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
Additional�®escriptio,p of project if necessary:
Job Address: ()- 4� C1 r k s A e)- C -( f ' eo 7-
r e rc _
Legal Description (if applicable) ,. Zee " -- / I le
/
'351
Owner: 17 i " i `'' CA S r k Address:
Phone #: q) 6 1) 3 � �
Contractor:
Phone #:
Address:
Cell :
6 '.
Application for Permit Fee $40 + Issuance Fee $25 + $50 Deposit
Egress Window (floor plan drawing required)
Fences (plot plan required)
Gazebos (plot plan required)
Patios /Driveways /Sidewalks (new or replacement)
Roofing/Siding/Soff it and /or Eave Repair /Gutters
Swimming Pools with Fence (plot plan required)
Window /Door Replacement (size change only)
Miscellaneous Building Permits (items not covered by one of the above)
Description:
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Lin. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
Additional,Descriptio,p of project if necessary:
17Zi7Txi�il���iT7►�iG��[�ll A
Job Address: I )-� r� f + 0 f j C i -
Legal Description (if applicable)
Owner: � i � � % CA 5 Address:
Contractor ., k
Fee: $115.00
Phone #:J )
Phone #:
Address: Cell #:
PERMIT RENEWAL FEE:
This fee is based on the amount of the original permit fee and is charged when work is not
completed within two years and the permit expires. Renewals will g"I be allowed with the
stipulation that all exterior site work and outside finish work is completed and interior life -
safety issues have been properly address. Permit renewals are for one (1) year, with a
maximum of two (2) renewals for a maximum permit span of four (4) years.
Original valuation of $0$50,000 $150.00 $
Original valuation of $50,000 - $100,000 $200.00 $
Original valuation of $100,000 - $500,000 $300.00 $
Original valuation of $500,000 or more $400.00 $
Issuance Fee: $ 25.00
Deposit: $ 50.00
Total Renewal Remit Fee = Permit Fee + Deposit + Issuance Fee $
Separate permits are required for electrical, plumbing, hearting, ventilating and air conditioning, and septic
systems. By my signature below, I acknowledge this building permit application 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 a permit 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 days or is not completed within two (2) years of date of issue.
7/ 12
Date
For Office Use Only
Date Permit Paid:
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
# ' , Approved by:
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
THANK YOU /- THIS COPY FOR YOUR RECORDS.
No 2 7036
RECEIVED BY
Pounds Printing, Blair, NE 68008
"V111-
A $500.00 refundable deposit is being collected for any new commercial, new
residential, and any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
addition or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) Theft of water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
�e_�
ctor /Owner Contractor /Owner
City of Blair
I hereby agree to the above conditions, and understand that should any or
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
7 / 2 - X616
Date