MS-2010-00099_0001.tif t
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding Permit Application (402)426- 4191 -Phone
(402) 426 -4195 -FAX
MS -2010 -00099 ° m /se of qJ� www.blairnebraska.org
09/0312010 MISC Residential September 3,
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LOCATIONOFIMPROVEMENT: 2415 Nebraska St, Blair, NE 68008
ARCHITECT:
GENERAL
OWNER: Donald E Jr And Sarah Jo Jensen
CONTRACTOR: Don Jensen
��� 1045 S St
1045 South St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME
PERMIT EXPIRES 09/0212012
2415 N ebraskaSt- 100903 -Roof
ESTIMATED COMPLETION DATE 2010 -09 -07
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DESCRIPTION OF WORK
Tearing off and replacing with asphalt shingles
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA j
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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1. No work will be started before a permit is ISSUED 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, ventilating and air conditioning, and septic system.
4. The undersigned owner or agent understands and acknowledges this building permit application does not constitute issuance of
this building permit. It is further understood that construction covered by this permit application shall not be commenced until a
copy of a permit signed by the Building Inspector is issued.
5. The undersigned owner or agent agrees 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. Any omission of or misrepresentation of
fact with or without the intention of the undersigned or any alteration or 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