Application.tif i
1111712015 15:53 4029955357 SUDBECK PAGE 02/02
�- CiTYOIF BLAIR
218 S.1fiTH STRERT
BLAIR,NEBRASKA 68
88
8Buildingi Application (402)428-4191 -Phone
-2a5-0 (402)426
-4106-FAXR ' 0 " 4a
www.blalrnebroaka.org
oil
1/10312015 REB-NEIN Residential November 15,2015
i.CCAT1ONOi*IMPROVEMENT. 1017 Joann ter,Blair,NE 68008 N
ARCHITECT.,
GENERAL Melvin Sudbeck Homes, inc. '
a COMER! Malvin 5udbock Homes, Inc. CONTRACTOR,
15255 Woodland Dr
76265 Woodland dr Omaha, NE 68138
Omaha, NE 68138
E
NATURE OF WORK STRUCTURE
New Construction Primary Structure
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PROJECT NAME PERMIT EXPIRES 05103/2016
1017Joannbr-151103-New Roaidential
ESTIMATED COMPLETION DATE 5131/2016
DESCRiPTION OF WORK
Now House
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Melvin Sudback Homes
RESchocktCOMcheck SUBMiTTED: Received
DEPOSIT STATUS:
$500 BUILDING PIANS SUBMITTED: Received
1. No work will be started before a permit is ISSUE AND POSTED.
2. For commercial permits,a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical,plumbing,heating,ventil-acing and air conditioning, and septic system,
4.The undersigned owner or agent understands and acknowledges this building permit application does not 0r:rnstitu#e issuance of
this building permit. it is further understood that construction Covered by this permit application shall not b
copy of a permit signed by the Building Inspector is issued, e commenced until a
5,The undersigned owner or agent agrees to perform the proposed work in acoordance with the speoirlcation�, set fCrth a
00ve and
in accordance with the Codestordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or without the intention of the undersigned or any alteration cr change from this application without approval of the
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Signature of Applicant
Date -
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