MS-2012-00372_0001 (2).tif 09/17/2012 08:38 571171: SC CC1NSTPUCTION PAGE 05
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Wry of St AIR
'218 S. 18TH STREET
BLAII2, NEBRASKA
u� f it. Iicatil n (402)47"191- 1
(402)426-4196-FAX
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t!'B1101 tM MIStr t�QSidantlsi Sapfember 10, "12
COGAT it3F1A�FiC1V lV M N 1Qth Ave, Blair,, NE 0900
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'Chan A.vt � B 41. Cc ruct0
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S5t141 GQ Rd A0
053 H 14ih Ave fort Calhow, NE W23
Blair, 88008-1 U1
NATURE OF WORK PROPOSED US '
patitafDriveWitagy Pr" ftesldertce �
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PROJECT NAME PERMIT EXPIRES trar#air�o�a i
653k10#hAva42W04)dww&y
ESTIMATED COMPLETION DA T9 IW3112012
DESCRIPTION OF 11Ai?ORK 3
Repouring Dommy-extenoft a aft on tha south side.
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DEP13Srr PAID .81(: WM F'l.AN SUBMITTED: Recaeived
contmotor
REScMckACOMCh*ck 8t I0Mri 0. NA
ORPOSiT STA TUS:
BUILDING PLANS SU131SIT TED: NA
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1. No work tie 1 be etarted before a.perrnit le 133t#ED AND P..OST_EDD. `
2. For commensal permits, a set of ptarm for this pra�ect must be submitted to the Nebraska State Fire Marahal's Office far review. I
3. $Tate permits am requitetl'far eledrteat, plumbing, heating, ventila ft and air condit ring, and septic system.
4. The undersigned uumer or agent ilnderstands and ackm wledges this building permit - application . dM not mnstitula iesttanre of
this building permit, It is Mther and toad that construction Covered by tNs permit ,application shall not be commenced 00to a �
ropy of a permit signed by the Building inspector is issued.
5, The Und0rsigr ed a dr agent agree$ to perform the proposed work in scoo lance mM the spsaiflaatidns Set #orth above anal
in aceordana fi - th esfordlnances of the City of Blair and the States opt Nebraska. Any otrtlssiart of or Misrepreselntation of
fact with w3tho th tentlon the nderotgned or any alteration or change from this application etith M appmval of the
Qulldi Official ituts. ground for Me revocation of any ,permit issued .wNch was based -on the apptrnral this ` I
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