MS-2010-00116_0001.tif i
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CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
s � (402) 426 -4195 - FAX
MS- 2010 -00116 e of www.blairnebraska.org
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09/16/2010 MISC Residential September 16,
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LOCATIONOFIMPROVEMENT. 1155 South St, Blair, NE 68008
ARCHITECT: GENERAL
Edmond Earl Iii And Pamela Susan
OWNER: Edmond Earl Iii And Pamela Susan Talbot CONTRACTOR: 'f0uth St
,F 1155 South St BLAIR, NE 68008 -0000
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BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
PatiolDriveway Driveway
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PROJECT NAME PERMIT EXPIRES 09/1512012
1155SouthSt- 100916- Driveway permit
ESTIMATED COMPLETION DATE 2010 -11 -30
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DESCRIPTION OF WORK
Driveway Permit
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
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.
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Date
Signat re of Applicant
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