PB-2010-00193_0001 (2).tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426 -4191 -Phone
PB -20� -0193 ��omi ��. (402) 426- 4195 - FAX
se of a www.blairnebraska.org
POLEBARN Residential
10/26/2010 October 29, 2010
N1 LOCATION OF IMPROVEMENT: 12686 Co 27 Rd, Blair, NE 68008
ARCHITECT:
GENERAL Jorgensen Contracting, Inc.
OWNER: Kari & Kurt Loseke CONTRACTOR: 530 Front St
12686 Co 27 Rd Blair, NE 68008
Blair, NE 68008
NATURE OF WORK PROPOSED USE
New Construction Pole Barn
PROJECT NAME PERMIT EXPIRES 10125/2012
12686Co 27Rd- 101014 -Pole Barn
ESTIMATED COMPLETION DATE 2010 -12 -31
DESCRIPTION OF WORK
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Construct new wick building 30'x50'x12' - 1500 sq. ft. partial concrete floor- No Electrical
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received !
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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. c� e
Date
Signa4 re of Ap Iioant
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