MS-2012-00443_0001.tif I
i
CITY OF BLAIR
218 S. 16TH STREET
w BLAIR, NEBRASKA 68008
Building Permit Application (402)426 - 4191 -Phone
(402) 426 -4195 - FAX
MS - 2012 - 00443 " ° '�n,, se of www.blairnebraska.org
Ell
10/09/2012 MISC Residential October 9, 2012
i
LOCATIONOFIMPROVEMENT: 2023 Northridge Cir, Blair, NE 68008
ARCHITECT.
®; GENERAL SELF
OWNER: Joseph C Iv And Christina L Peleska CONTRACTOR:
2023 Northridge Cir Blair, NE 68008
BLAIR, NE 68008 -4204
J Via: { Lw :; O c
sa, _
f a
� N Tx'a" �� iy�_ ,.,� '�"`u���� -� .tea K �3a� . i3 . m.` '"'✓'h` G
NATURE OF WORK PROPOSED USE
Misc. Permit Primary Residence
i
i
PROJECT NAME PERMIT EXPIRES 1010912014
2023NorthridgeCir- 121009 ESTIMATED COMPLETION DATE 121912012
DESCRIPTION OF ORK
Adding Conceret to Drive.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheck SUBMITTED: Received
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
i
I
m
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-
pp..w ation.,..
Date
Signature of Applicant "`