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2. CITY OF FAIRBURY, NEBRASKA

4. 
   

   APPLICATION FOR BUILDING PERMIT

   
   

6. Date:
   Date:
8. Owner:
9. Contractor/Builder:
11. Home Address:
12. Address:
14. City, State, Zip
15. City, State, Zip
17. Email Address:
19. Telephone:
20. Telephone:
22. Address/Location where work is to be done:
23. Total Price of Construction:
25. Legal Description:
27. Description of Work
    -- Select One --NewAdditionRepairRemodelPlacement (Moving)
28. Type of Building:
    -- Select One --ResidenceCommercialIndustrialAccessory
30. What type of Accessory:
32. Building/Addition Size:
34. Width:
35. Length:
36. Height (overall):
37. Sidewall Height:
39. State
40. Zip Code
42. Phone Number
44. Lot Size:
46. Building Yard Setbacks:
48. Front:
49. Sides:
50. Rear:
52. Proposed Use:
54. Frame:
    -- Select One --WoodMetalBrick/ConcreteBlockOther
56. Materials:
58. Foundation:
59. Roofing:
60. Siding:
62. If Prefabricated or Manufactured, - (Name of Company):
63. When required, name of licensed architect or engineer:

65. I swear to the best of my knowledge that the information here given and any attached materials are true and complete and that the work done will be in accordance with the Fairbury Municipal Code, the Zoning and Subdivision Regulations, and the adopted Building, Fire, Electrical and Plumbing Codes.

67. Owner Signature
68. Builder or Contractor Signature
70. Attach File
72. Fee Information
    Building/Zoning Permit Info
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit Submit and Print

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