AD-2011-00288_0001 (2).tif i
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CITY OF BLAIR
r. 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding P ermit Application (402)426- 4191 -Phone
AD- 2011 -002$$ a'on Jo``ti� (402) 426 -4195 - FAX
he of a www.blairnebraska.org
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07/27/2011 brwheele ADDITION Residential rAugust 3, 2011
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LOCATIONOFIMPROVEMENT: 653 N 12th St, Blair, NE 68008
ARCHITECT: GENERAL Hoffschneider Construction Co.
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OWNER: Barbara J Triplett CONTRACTOR: PO Box 587
653 N 12th Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Addition Primary Residence
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PROJECT NAME PERMIT EXPIRES 08/02/2013
653N1 2thSt-1 10727-Addition ESTIMATED COMPLETION DATE
2011 -12 -31
DESCRIPTION OF WORK
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Addition onto back of the house with new deck attached to the addition. Extending kitchen and living room.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
$500
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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 O c' , sh t constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
pli ion
Signature ofApplica t Date