MS-2012-00264_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Permit A pplication
(402)426- 4191 -Phone
(402) 426 -4195 - FAX
MS- 2012 -00264 ° �hise 01 www.blairnebraska.org
07/05/2012 bpeterse MISC Residential July 5, 2012
LOCATIONOFIMPROVEMENT: 1425 Prospect Ave, Blair, NE 68008
a ARCHITECT: GENERAL Matzen Construction, Inc.
AM
OWNER: Ember Arnold CONTRACTOR: 2402 Lincoln St
1425 Prospect Ave Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Patio /Driveway Primary Residence
PERMIT EXPIRES 07105/2014
PROJECT NAME
1425ProspectAve- 120705 - Driveway ESTIMATED COMPLETION DATE 7/1012012
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DESCRIPTION OF WORK
Repouring driveway in same footprint.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Held
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
appli ati n.
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Date
Sig ature of Applicant