MS-2010-00108_0001.tif i
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From:MCKINNIS ROOFING & SHEET METAL 402 426 2344 09/2912010 13:35 #724 P.003(003
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CITY OF BLAIR
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218 S. "18TH STREET
BLAIR, NEBRASKA 68008
B Pe rmit Application ( 402)426.4191 -Phone
MS -2.10- 00108 4r �iles of 4JQ``�.
(402)4264195-FAX
www ela rnebraska
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09113120.10 MISC Resldentlal September 13,
LOCATIONOFIMPROVWENT: 12364 Rose Dr, Blair, NE 68008 1
At2GiFPECT: GE TER&
e OVER: Dave Delisle CONTRACTOR: McKinnis Roofing & Sheet Metal
164 S 1st St
12364 Rose Dr Blair, NE 68008 1
Blair, NE j
NATURE OF WORK PROPOSED USE
RaofinglSofffUEaves /Gutters
Primary Residence
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PROJECT NAME PERMIT EXPIRES 09112/2012
12364RoseDr- 1009 (3 -Root ESTIMATED COMPLETION DATE 2010 -09-30
DESCRIPTION OF WORK j
Replacing entire roof with asphalt shingles
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor 1
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 planks 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 ( j
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
applicat'
Signature of Appfi, n 6 P-t
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