MS-2012-00231_0001.tif CITY OF BLAIR
218 S. 16TH STREET
Building Permit Application ( 402 ) 426 - 4191- Pho ne oos
o � (402) 426-4195 FAX
MS- 2012 -00231 �' 7 Ise of a www.blairnebraska.org
06/0812012 bpeterse MISC Residential June 8, 2012
LOCATIONOFIMPROVEMENT: 2215 Hollow Rd, Blair, NE 68008
ARCHITECT:
n¢ GENERAL SELF
OWNER: Jacque A Belles CONTRACTOR:
2215 Hollow Rd Blair
NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Misc. Permit Primary Residence
PROJECT NAME PERMIT EXPIRES 06108/2014
2215HollowRd- 120608 - Siding ESTIMATED COMPLETION DATE 711/2012
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DESCRIPTION OF WORK
Vinyl siding entire house.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS; BUILDING PLANS SUBMITTED: NA
$50
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 ithout approval of the
B ilding Official, shall constitute sufficient ground for the revocation of any permit issued which was based n the approval of this
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i atureofApplicant Date