MS-2011-00430_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
P @i"fltl� l4pp�IC�tlOf1 (402)426- 4191 -Phone
Building
(402) 426 -4195 - FAX
MS- 2011 -00430 se of www.blairnebraska.org
10/03/2011 MISC Residential October 3, 2011
- LOCATIONOFIMPROVEMENT: 1067 N 27th St, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Walker Preston Harris CONTRACTOR:
1067 N 27th St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Misc. Permit Patio
PROJECT NAME PERMIT EXPIRES 10/02/2013
106 7N27th st - 111003 -1 ESTIMATED COMPLETION DATE 2011 -10 -31
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DESCRIPTION OF WORK
22' x 12' new concrete patio
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
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Owner
REScheck /COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
IMM
111 2212
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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,
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Date
Signature of Applicant
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