MS-2012-00062_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
402
wilding Permit Application ( ) 426 -4191- Phone
9 ti a°
(402)426-4195-FAX
MS 2012 - 00062 e of o www.blairnebraska.org
03/1412012 bpeterse MISC Residential March 14, 2012
LOCATIONOFIMPROVEMENT: 674 N 27th St, Blair, NE 68008
ARCHITECT:
GENERAL Hammerhead Construction
OWNER: Dale A And Deloris B Matson CONTRACTOR: 14721 Hwy 75
732 N 27th St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Siding Primary Residence
PROJECT NAME PERMIT EXPIRES 0311412014
674N27thSt- 120314- Siding
ESTIMATED COMPLETION DATE 2012 -03 -31
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DESCRIPTION OF WORK
Re- siding with vinyl siding.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
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Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Held
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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 undersig}4d owner o agent agrees to perform the proposed work in accordance with the specifications set forth above and
in a�?itrh da d with th c des /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fac r we
th intention of thy- nd ' ned or any alteration or change from this application without approval of the
it fficial, constit a ent grow for the revocation of any permit issued which was based on the approval of this
p ion.
Date
ignature of Applicant
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