MS-2011-00179_0001.tif I
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
MS- 2011 -00179 0 (402) 426 -4195 - FAX
�>,s a� www.blairnebraska.org
05/23/2011 bpeterse MISC Residential May 23, 2011
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LOCATIONOFIMPROVEMENT: 1286 Skyline Dr, Blair, NE 68008
ARCHITECT:
}; GENERAL CBConstruction
OWNER: Donovan L And Kelly R Petersen CONTRACTOR: 19281 Shadow Ave
1286 Skyline Dr Honey Creek, IA 51542
` BLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
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PROJECT NAME PERMIT EXPIRES 05122/2013
1286SkylineDr- 110523 - Roofing ESTIMATED COMPLETION DATE 2011 -05 -31
DESCRIPTION OF WORK
Re- roofing entire house with asphalt shingles.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Held
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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
applica
Signature of Applicant Date
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