AC-2011-00167_0001 (3).tif f
e{ Y CITY OF BLAIR
218 S. 16TH STREET
` BLAIR, NEBRASKA 68008
402 426- 4191 -Phone
_ Building Permit Application ( >
AC- 2011-00167 ', ` (402) 426 -4195 - FAX
°� ? o , a www.blairnebraska.org
05/16/2011 ACCESS Residential May 24, 2011
LOCATIONOFIMPROVEMENT: 11323 Rambleridge Dr, Blair, NE 68008
ARCHITECT: GENERAL SELF
OWNER: Michael R And Kerry A Jonas CONTRACTOR:
III _ 218 Box Blair, NE 68008
BLAIR, NE 68008 -0218
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NATURE OF WORK PROPOSED USE
New Construction Accessory Structure
PROJECT NAME PERMIT EXPIRES 05/15/2013
11323RambleridgeDr- 110516- Accessory
ESTIMATED COMPLETION DATE 2011 -09 -01 �
DESCRIPTION OF WORK
16 x 20 Accessory structure to be used for storage. No electric.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Owner
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.
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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
uilding Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap lication.
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.�Si ureofApplicant Date