MS-2012-00240_0001.tif I
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CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426 - 4191 -Phone
`�. (402) 426 -4195 - FAX
MS 2012 - 00240 lse o+ Q www.blairnebraska.org
06/14/2012 bpeterse MISC Residential June 14, 2012
LOCATION OF IMPROVEMENT: 12861 Cord 26, Blair, NE 68008
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T ARCHITECT: GENERAL Warden Construction
OWNER: Jack R And Kristina J Barta CONTRACTOR: 14755 Co Rd 14
26 12861 Co 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 06/1412014
12861 Cord 26- 120614- Roofing 6/30/2012
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Re- roofing small house on the property with asphalt.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Held
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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.
Date
Sig ure of Applicant