AC-2011-00078_0001 (3).tif i
CITY OF BLAIR j
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426 - 4191 -Phone
�� (402) 426 -4195 - FAX
AC - 2011 -00078 �� /Se of qo www.blairnebraska.org
03/21/2011 ACCESS Residential March 28, 2011
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M LOCATIONOFIMPROVEMENT: 8874 Co P33 Rd, Blair, NE 68008
` ARCHITECT:
GENERAL SELF
OWNER: Jerry & Rebecca Fox CONTRACTOR:
1669 Washington St Blair, NE 68008
Blair, NE 68008
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NATURE OF WORK PROPOSED USE
New Construction Accessory Building - Primary Residence
PROJECT NAME PERMIT EXPIRES 03120/2013
8874Co P33Rd-1 10321 -Accessory Building ESTIMATED COMPLETION DATE 2011 -09 -21
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DESCRIPTION OF WORK
30 x 40 Accessory Building used for storage. No Electric.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor i
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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
(ding Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
,appl 'cation.
Si ture Q fAPPI14 Date