MS-2012-00128_0001.tif CITY OF BLAIR
218 S. 16TH STREET
i BLAIR, NEBRASKA 68008
1"�`) 61i i iE 1 ` wilding Permit Application (402)426 -4191 -Phone
�\ 4 (402) 426 -4195 - FAX
MS- 2012 - 00128 �'�n,, a,o�* www.blairnebraska . org
04/16/2012 MISO Residential April 16, 2012
i
LOCATIONOFIMPROVEMENT: 1477 Butler St, Blair, NE 68008
ARCHITECT:
GENERAL SELF
x: OWNER: Kevin C And Angela S Eggena CONTRACTOR:
6`,_' 1477 Butler St Blair, NE 68008
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BLAIR, NE 68008 -0000
Y.
NATURE OF WORK PROPOSED USE I
Patio /Driveway Primary Residence
PERMIT EXPIRES 04/1612014
PROJECT NAME
1477ButlerSt- 120416 - Concrete Patio ESTIMATED COMPLETION DATE 2012 -05 -15
DESCRIPTION OF WORK
I
Concrete patio to be tore out and replaced in the same spot in the backyard.
DEPOSIT PAID BY, SITE PLAN SUBMITTED, Received
Contractor
REScheck /COMcheck SUBMITTED, NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED, NA
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
it ing Offici , shall onstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap cation.
Date
Signature o� pp icant