MS-2012-00454_0001.tif i
CITY OF BLAIR
r 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
222�1 402 426- 4191- Phone
uilding ermitApplication ( ) ��(402) 426 -4195 - FAX
2 -00454 l �M/s e °1 a www.blairnebraska.org
1011212012 brwheele MISC Residential October 12, 2012
LOCATIONOFIMPROVEMENT: 1965 Washington St, Blair, NE 68008
ARCHITECT:
GENERAL Jeremy Lange
F OWNER: Nicole Watzke CONTRACTOR: 4025 Pfeiffer Ln
1965 Washington St ARLINGTON, NE 68002
� BLAIR, NE 68008 -0000
AN
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Resaidence
PROJECT NAME PERMIT EXPIRES 1011212014
1965WashingtonSt- 121012 - Roofing ESTIMATED COMPLETION DATE 11112/2012
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DESCRIPTION OF WORK
Replacing Roof with Asphalt shingles
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signature of App' nt
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