MS-2011-00305_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 - 00305 a'�n/so of oo °`' www.blairnebraska.org
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08111/2011 bpeterse MISC Residential August 11, 2011 7
LOCATIONOFIMPROVEMENT: 652 S 23rd St, Blair, NE 68008
ARCHITECT: GENERAL BC Construction
OWNER: William L And Nan C Smutko CONTRACTOR: 5041 Co Rd 40
652 S 23rd St Fort Calhoun, NE 68023
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Patio /Driveway Primary Residence
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PROJECT NAME PERMIT EXPIRES 0811012013
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652S23rdSt- 110811 -Driveway ESTIMATED COMPLETION DATE
2011 -08 -20
DESCRIPTION OF WORK
Replacing existing driveway in same footprint.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 and ' ersrgne , 6wnero4 gent agrees to perform the proposed work in accordance with the specifications set forth above and
in ac drdanc wh the co a /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact' with or wit , ut the i e tion of the undersigned or any alteration or change from this application without approval of the
13uildr g Off j , shall co titu a sufficient ground for the revocation of any permit issued which was based on the approval of this
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Date
i atureofApplicantfi_�—