MS-2011-00147_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
®- Building Permit Application (402)426- 4191 - Phone
(402) 426 -4195 - FAX
MS 2011 -00147 Ise of q� www.blairnebraska.org
0510312011 bpeterse MISC 7Residential May 3, 2011
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LOCATIONOFIMPROVEMENT: 2121 Crestridge Dr, Blair, NE 68008
r. ARCHITECT: GENERAL Matzen Roofing
OWNER: Stephen Lemon CONTRACTOR: PO Box 561
2121 Crestridge Dr Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 0510212013
2121 CrestridgeDr- 110503- Roofing
ESTIMATED COMPLETION DATE 2011 -05 -15
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DESCRIPTION OF WORK
Tearing off and replacing 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
application
�Signat6re of Applicant Date