AC-2012-00234_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET NEBRAKA
Building Permit Application (4 2)426 41191 SPhone
(402) 426 -4195 - FAX
AC- 2012 -00234 9 ' °m ' °'` www .blairnebraska.org
06/11/2012 ACCESS Residential June 14, 2012
x LOCATIONOFIMPROVEMENT: 2065 Grant St, Blair, NE 68008
ARCHITECT:
GENERAL SELF
,� OWNER: Scott D And Terri D Monzon CONTRACTOR:
2065 Grant St Blair, NE 68008
BLAIR, NE 68008 - 0000
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NATURE OF WORK PROPOSED USE
New Construction Accessory Building
PROJECT NAME PERMIT EXPIRES 12109/2012
2065GrantSt- 120611 - Accessory Building
ESTIMATED COMPLETION DATE 10/1/2012
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DESCRIPTION OF WORK
37 X 16 Accessory Building in backyard.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
ryry¢ 7 pp qq y g
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
B i din Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap I °cati n.
Signature of Appl cant Date
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