MS-2012-00396_0001.tif I
Sep 20 12 05:37p Lee McCoy 4028841626 p.3
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CITY OF BLAIR
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218 S. 16TH STREET"
BLAIR, NEBRASKA 68008
Building P ermit Application {402)426.4191 -Phone
(402)426- 4195 -FAX
MS- 2012 -00396 �'� S p Q�a� f www.blairnebraska.org
09f2012012 bpeterse MISC Residential September 20, 2012
LOCA110NOFIMPROVEMENT: 101 N 25th St, Blair, NE 68006
ARCHrIECT. GENERAL. Antler Roofing and Repair
ER Thomas >= And Cynthia J Rivera CONTRACTOR 2833 N 205th St
7210 N 122nd Ave ELKHORN, NE 68022
OMAHA, NE 66142 -0000
NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 09/2012014
101 S25thSt- 120920- Roofing
ESTIMATED COMPLETION DATE 9/2412012
DESCRIPTION OF WORK
Tearing off and replacing with Asphalt Shingles
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor j
REScheck1COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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. J
Date
Signature of Applicant