RN-2012-00042_0001.tif CITY OF BLAIR
218 S. 16TH STREET
s , BLAIR, NEBRASKA 68008
402
a Building Permit Application ( )426 -4191 -Phone
(402) 426 -4195 - FAX
RN - 2012 -00042 �n;, www.bIairnebraska.org
03/06/2012 1 bpeterse RES -NEW Residential May 24, 2012
LOCATIONOFIMPROVEMENT: 11451 Cord 18, Blair, NE 68008
ARCHITECT:
GENERAL J Nielsen Construction LLC
OWNER: Dale And Ann Clark CONTRACTOR: 1730 State St
18 11451 Co Rd BLAIR, NE 68008 -1568
BLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
New Construction Primary Residence
PROJECT NAME PERMIT EXPIRES 05/24/2014
11451Co Rd 18- 120306 -New Residential ESTIMATED COMPLETION DATE 11/1/2012
DESCRIPTION OF WORK
1.5 Story Home, 4 bedrooms, 4 baths, no basement crawl space, 3 car garage.
DEPOSIT PAID BY: SITE PLAN SUBMITTED- Received
Contractor
REScheck /COMcheck SUBMITTED: Received
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
N/A
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
�.�plication _
Signature of Applica t Date