RN-2012-00005_0001 (2).tif CITY OF BLAIR
218 S. 16TH STREET
r BLAIR, NEBRASKA 68008 }
Building Permit Application (402)426 -4191- Phone
(402) 426 -4195 - FAX
RN -2012 -00005 mus or a °° www.blairnebraska.org
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01/05/2012 RES -NEW Residential January 16, �201
LOCATIONOFIMPROVEMENT: 8990 Golden Pond Ln, Blair, NE 68008
ARCHITECT:
GENERAL J Nielsen Construction LLC
OWNER: Kevin D And Rosemary A Hartzell CONTRACTOR: 1730 State St
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12327 Cuming St BLAIR, NE 68008 -1568
ri OMAHA, NE 68154 -0000
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NATURE OF WORK PROPOSED USE
New Construction Primary Residence
PROJECT NAME PERMIT EXPIRES 01/04/2014
8990Golden Pond Ln- 120105 -New Residential 2012 -09 -30
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
New two story 4 bedroom, 3.5 baths, unfinished basement, 3 car garage.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
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DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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.-.-,-
Signature ofApplic nt Date
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