MS-2011-00539_0001.tif /1 > CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building ermit Q Ap (402)426- 4191 -Phone
g p p (402) 426 -4195 - FAX
MS- 2011 -00539
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12/02/2011 bpeterse MISC Residential December 5, 2011
LOCATIONOFIMPROVEMENT: 2169 Nebraska St, Blair, NE 68008
ARCHITECT:
GENERAL Hammerhead Construction
OWNER: Adam And Christy Lippincott CONTRACTOR: 14721 Hwy 75
14721 US Hwy 75 Blair NE 68008
BLAIR, NE 68008 -5563
NATURE OF WORK PROPOSED USE
Siding Primary Residence
PROJECT NAME PERMIT EXPIRES 12101/2013
i
2169NebraskaSt-1 11 202-Siding ESTIMATED COMPLETION DATE 2011 -12 -09
DESCRIPTION OF WORK
Residing entire house with vinyl siding.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Held
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.
Signature of Applicant Date