RE-2011-00219_0001.tif , CITY OF BLAIR
218 S. 16TH STREET
'j BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
;= , (402) 426 -4195 - FAX
RE- 2011 -00219 r��;; Q,� www.blairnebraska.org
06/1512011 REMODEL Commercial June 22, 2011
LOCATIONOFIMPROVEMENT: 353 S 16th St, Blair, NE 68008
ARCHITECT:
GENERAL D.A. Boswell Company
OvVvER: Church Congregational CONTRACTOR: 19811 Co Rd P21 Rd
HERMAN, NE 68029
BLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
Sub -Work New Const Church
PROJECT NAME PERMIT EXPIRES 06/14/2013
353S16thSt- 110615 - Church Remodel
ESTIMATED COMPLETION DATE 2011 -09 -01
DESCRIPTION OF WORK
Remodeling office area to make it two separate rooms.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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
applicat� io n
Signature of Applicant $ Date