MS-2011-00559_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
��, Building ..m Permit Ap plication
(402)426- 4191 -Phone
f (402) 426 -4195 - FAX
MS -2011 -00559 "Ise of Q
111 0 i !I!
12/20/2011 bpeterse MISC Residential December 20, 2011
LOCATIONOFIMPROVEMENT:
849 S 16th St, Blair, NE 68008
ARCHITECT: GENERAL SELF
OWNER: Michael D And Angela Isham - Procha CONTRACTOR:
Blair, NE 68008
BLAIR, NE 68008 -0000
Oil
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NATURE OF WORK PROPOSED USE
Roofing /SoffitlEaves /Gutters Accessory Building
PROJECT NAME PERMIT EXPIRES 12/19/2013
849S16thSt- 111220 - Roofing ESTIMATED COMPLETION DATE 2012 -02 -29
DESCRIPTION OF WORK
Re- roofing small detached garage.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
NA
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
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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.
C D
Signature of Applicant Date