AD-2011-00243_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building
402 426- 4191 - Phone
Permit Application � �
(402) 426- 4195 - FAX
AD- 2011 -00243 A 'on,� se a t i a� °`` www.blairnebraska.org
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06128/2011 ADDITION Residential February 29, 2012
LOCATIONOFIMPROVEMENT: 1937 Soren Dr, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: David W And Jann M Dibben CONTRACTOR:
1937 Soren Dr Blair, NE 68008
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BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Addition Primary Residence
PROJECT NAME PERMIT EXPIRES 08/2512012
1937SorenDr- 110628- Addition ESTIMATED COMPLETION DATE
2012 -03 -21
DESCRIPTION OF WORK
Three Season Room Addition. Will be enclosing the existing deck for the three season room.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Owner
REScheck/COM check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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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
ASignatu with or without the intention of the undersigned or any alteration or change from this application without approval of the
ing Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
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