AC_2012_00384_0001.tif CITY OF BLAIR
218 S. 16TH STREET
l �� i � 1 BLAIR, NEBRASKA 68008
Building Permit Application (402)426 - 4191 -Phone
(402) 426 -4195 - FAX
AC- 2012 -00384 �' 5�; ��c`'� www.blairnebraska.org
09/14/2012 ACCESS Residential September 18, 2012
LOCATIONOFIMPROVEMENT: 622 N 14th Ave, Blair, NE 68008
ARCHITECT:
1:. GENERAL SELF
i1 OWNER: Harvey D And Julie Shuster CONTRACTOR:
Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
New Construction Accessory Building
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PROJECT NAME PERMIT EXPIRES 09/1412014
622N14thAve- 120914 - Garage ESTIMATED COMPLETION DATE 11/1/2012
DESCRIPTION OF WORK
12 x 24 detached shed /garage used for misc. lawn equipment storage.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Owner
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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
ildin Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
a plica ion.
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gh re fApplicant Date