MS_2012_00407_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
MS- 2012 -00407 a ' °n, °l q o ° www.blairnebraska.org
09/24/2012 p b eterse MISC Residential September 24, 2012
LOCATIONOFIMPROVEMENT: 1435 South St, Blair, NE 68008
ARCHITECT:
GENERAL Matzen Construction, Inc.
OMER: Joel D And Virginia M Fredericksen CONTRACTOR: 2402 Lincoln St
1435 South St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Patio /Driveway Primary Residence
PROJECT NAME PERMIT EXPIRES 09/24/2014
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1435SouthSt- 120924 -1 ESTIMATED COMPLETION DATE 912412012
DESCRIPTION OF WORK
Tearing up and replacing driveway
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA j
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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
Buildi Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app/ a n. -
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Signature of Applicant
Date