MS-2011-00431_0001.tif I
CITY OF BLAIR
°v 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
®
Building P ermit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
MS -2011 -00431 lO m/se 01 q o° www.blairnebraska.org
10/03/2011 MISC Residential October 3, 2011
LOCATIONOFIMPROVEMENT: 1168 Park St, Blair, NE 68008
r ARCHITECT:
®q -- GENERAL SELF
i OWNER: Lee A Colgrove CONTRACTOR:
1168 Park St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Siding Primary Structure
I
PROJECT NAME
PERMIT EXPIRES 10/0212013
1168ParkSt- 111003 -2
ESTIMATED COMPLETION DATE 2012 -07 -31
DESCRIPTION OF WORK
Reside entire house
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
movil
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
apps tion.
Date
Sig4tureofApplicant
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