MS-2012-00302_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Applicatio ( )
402 426 -4191- Phone
(402) 426 -4195 - FAX
MS 2012 - 00302 ' °nos 01 a� °' www.blairnebraska.org
07/25/2012 bpeterse MISC Residential July 25, 2012
LOCATIONOFIMPROVEMENT: 2138 Park St, Blair, NE 68008
ARCHITECT:
� GENERAL SELF
OWNER: Marty L And Polly A Shepard CONTRACTOR:
2138 Park St Blair, NE 68008
BLAIR, NE 68008 -0000
01 W
Is ONE
MUM 0*0117
IM
1 V
ONE
_ PROP ®SED USE
NATURE OF WORK
Misc. Permit Primary Residence
PROJECT NAME PERMIT EXPIRES 07/25/2014
2138ParkSt- 120725- Miscellaneous 7/25/2013
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Re- roofing, re- siding, window replacement. Framing in one window in bathroom.
I
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
NA
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
„l
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
Signature of Applicant