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CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
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Building ermit Application (402)426- 4191 - Phone
�,. (402) 426 -4195 - FAX
M$- 2012 -00116 Ar �mtge of gJOp www.blairnebraska.org
04109/2012 MISC Residential April 9, 2012
LOCATIONOFIMPROVEMENT: 821 N 14th Ave, Blair, NE 68008
ARCHITECT:
IN M GENERAL HDG, Inc.
E) OWNER: Arlan F And Mary Ann Hansen CONTRACTOR: 3493 Co Rd G
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821 N 14th Ave Tekamah, NE 68061
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Residental structure
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PROJECT NAME
PERMIT EXPIRES 04/0912014
821N14thAve- 120409 - Roofing ESTIMATED COMPLETION DATE 2012 -05 -01
DESCRIPTION OF WORK
Tear off one layer, replace with asphalt on principal structure
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
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 he revocation of any permit issued which was based on the approval of this
- . - - -..- .application., -e
Date
Signature of Applicant