AD-2012-00079_0001 (2).tif i� CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
� J�)!' �' - �� Building Permit Application (402)426 -4191 -Phone
(402) 426 -4195 - FAX
AD- 2012- 00079
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r��i of a" www.blairnebraska. ®rg
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03/2012012 ADDITION Residential March 28, 2012
q LOCATIONOFIMPROVEMENT: 2150 Park St, Blair, NE 68008
� ARCHITECT:
v GENERAL Bob Gerdes Construction
} OWNER: Dale M And Debbie J Co Trustee Olson CONTRACTOR: 948 N 24th Ave
2150 Park St Blair, NE 68008
�I ;r BLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
Addition Primary Residence
PROJECT NAME PERMIT EXPIRES 03/20/2014
2150ParkSt- 120320 - Addition ESTIMATED COMPLETION DATE
2012 -07 -31
DESCRIPTION OF WORK
All Seasons room attached to house.
DEPOSIT PAID BY. SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck 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
fact with or without the intention of the undersigned or any alteration or change from this application without approval of the
uilding Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
a plicati n.'
Date
nature of Applicant