MS-2010-00122_0001.tif IC I
From:MCKiNNIS ROOFING & SHEET METAL 402 426 2344 09127/2010 14 :56 #716 P.0021003
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CITY OF BLAIR j
216 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 419'1 -Phone
w (402)426 - 4196 -FAX
MS - 2814 -40122 ` www.btairnebraska.erg
09/x1/2010 M1SC Resldential 9eptember2l, 2010
LOCATIONOFIMPROVEMENT; 666 N 24th St, Blair, NE 68006
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ARCHITECT GENERAL. McKinnis Roofing & Sheet Metal
0' cxNNER: Dale J And Terry A Paulsen CQRrrRAG'rOR: 164 S 1st St
666 N 24th St Blair, NE 68008
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` BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE j
Roofing /Soffit/Eaves/Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 09120/2612
666N24thSt 100921 -Roof ESTIMATED COMPLETION DATE 2010 49.21
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DESCRIPTION OF WORK i
Remove and replace roof with asphalt shingles and replace section of the gutter.
DEPOSIT PAID BY: SITE FLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 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
applicatio .
Signature of Applicant Date