re-2011-00062_0007.jpg CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
A \�� (402) 426 -4195 - FAX
RE- 2011 -00062 0e` o, www.blairnebraska.org
03114/201
1 REMODEL Residential March 14, 2011
LOCATIONOFIMPROVEMENT: 1628 Colfax St, Blair, NE 68008
ARCHITECT:
e GENERAL Bob Gerdes Construction
e OWNER: First United Methodist Church CONTRACTOR: 948 N 24th Ave
° 1656 Colfax St Blair, NE 68008
BLAIR, NE 68008 -0000
SELECTED CH ARACTERISTICS OF •'
NATURE OF WORK PROPOSED USE
Remodel Primary Structure
PROJECT NAME PERMIT EXPIRES 03113/2013
1628ColfaxSt- 110314 -1 ESTIMATED COMPLETION DATE 2011 -06 -01
DESCRIPTION OF WORK
Basement remodel, new kitchen and master bath and walkin closet
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
AFFAI DAVIT OF
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
Signature of Applicant Date