MS-2011-00177_0001.tif CITY OF BLAIR
C _ 218 S. 16TH STREET
t BLAIR, NEBRASKA 68008
Building Permit ApplICatl011 (402)426- 4191 -Phone
(402) 426 -4195 -FAX
MS- 2011 -00177 S � a; ��" www.blairnebraska.org
05120/2011 MISC Residential May 20, 2011
LOCATIONOFIMPROVEMENT: 1228 South St, Blair, NE 68008
ARCHITECT:
GENERAL Dan Militti
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OWNER: Jason C Shryock CONTRACTOR: 1641 Monroe
11361 Rambleridge Dr OMAHA, NE 68135
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Siding Primary Structure
PROJECT NAME PERMIT EXPIRES 05/19/2013
1228SouthSt- 110520 -1 ESTIMATED COMPLETION DATE 2011 -06 -30
DESCRIPTION OF WORK
Siding entire house with vinyl, soffits, gutters and window trim
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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
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Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap 'cation. v IN
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Signature of Applicant Date
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