MS-2010-00207_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
MS - 2010 - 00207 ;se o , www.blairnebraska.org
11/0212010 MISC Residential November 10, 2010
LOCATIONOFIMPROVEMENT: 1171 Maple Dr, Blair, NE 68008
Fllli ARCHITECT:
GENERAL Bart Moore Subcontracting, Inc.
OWNER: Edward And Delores A Peters CONTRACTOR: 841 N 24th Ave
h 1171 Maple Dr Blair, NE 68008
�x BLAIR, NE 68008 -0000
s
.< '..
I
NATURE OF WORK PROPOSED USE
Patio /Driveway Concrete Floating Slab
PROJECT NAME PERMIT EXPIRES 05/04/2011
1171MapleDr- 101102- Floating Slab
ESTIMATED C OMPLETI ON DACE 2010 -11 -30
DESCRIPTION OF WORK
24'x 30 floating slab for future garage. Garage will not be done at this time.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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, s II constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appltion.
Signature of Applicant Date