MS-2012-00385_0001.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Applicati (402)426 - 4191 -Phone
MS 201 00385 �,�� (402) 426 -4195 - FAX
��se oof °° www.blairnebraska.org
09/1412012 bpeterse MISC Residential September 14, 2012
LOCATIONOFIMPROVEMENT: 2181 Birch Cir, Blair, NE 68008
Q ARCHITECT:
GENERAL Duranski Roofing
y i OwNER: William J And Gwendolyn M Fillis CONTRACTOR: 1016 S 218th St
2181 Birch Cir
ELKHORN, NE 68022
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 09/14/2014
2181 BirchCir- 120914 - Roofing
ESTIMATED COMPLETION DATE 10/1/2012
DESCRIPTION OF WORK
Re- roofing 2181 & 2183 Birch Circle with asphalt shingles (duplex)
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: 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
,application.
_�tgnatureofApplicant Vate 1