MS-2011-00166_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
.,..Building Permit Application (402)426- 4191 -Phone
A _ ���� (402) 426 -4195 - FAX
MS- 2011 -00166 se of a www.blairnebraska.org
05116/2011 bpeterse MISC Residential May 16, 2011
LOCATIONOFIMPROVEMENT: 2038 Park St, Blair, NE 68008
ARCHITECT:
U GENERAL Olson & Stewart Construction Inc.
OWNER: Gladys M And Vernon H Christoffersen CONTRACTOR: PO Box 271
2038 Park St Blair, NE 68008
Y
AM
BLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
Patio /Driveway Primary Residence
PROJECT NAME PERMIT EXPIRES 05/1512013
2038 Pa rkSt- 110516 - Driveway
ESTIMATED COMPLETION DATE 2011 -05 -30
DESCRIPTION OF WORK
Replacing driveway in exact footprint.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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.
Date
Signature of Applicant Q