MS-2012-00098_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building P ermit Application (402)426- 4191
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MS 2012 - 00098 � a� °�� www.blairnebraska.org
04/02/2012 bpeterse MISC Residential April 2, 2012
LOCATIONOFIMPROVEMENT: 837 N 12th St, Blair, NE 68008
ARCHITECT:
GENERAL Tim Anderson Custom Construction Inc.
OWNER: Nila J Matzen CONTRACTOR: 1121 Nebraska St
837 N 12th St Blair, NE 68008
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BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME
PERMIT EXPIRES 04/02/2014
837N12thst- 120402 - Roofing ESTIMATED COMPLETION DATE 2012 -04 -15
DESCRIPTION OF WORK
Re- roofing home with asphalt shingles.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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 the revocation of any permit issued which was based on the approval of this
application
_34 l /
Date
Signature of Applicant