RN-2011-00460_0001.tif - CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426 -4191 -Phone
� °��', �` ��` (402) 426 -4195 - FAX
RN- 2011 -00460
° t1isu ° www.blairnebraska.org
10/1812011 RES -NEW Residential October 25, 2011
LOCATIONOFIMPROVEMENT: 2868 Ravae Ln, Blair, NE 68008
ARCHITECT: GENERAL SELF
OWNER David Allen & Lynne Jackson CONTRACTOR:
2712 Iowa St Blair, NE 68008
OMAHA, NE 68112
NATURE OF WORK PROPOSED USE
New Construction Primary Residence
PROJECT NAME PERMIT EXPIRES 10/17/2013
2868RavaeLn- 111018 -New Residential ESTIMATED COMPLETION DATE 2012 -06 -01
DESCRIPTION OF WORK
Modular 3 bedroom, 2 baths, ranch style, unfinished basement with rough in bathroom in basement, 2 car garage,
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: Received
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
a plicatlon
ignature of Applicant Date