MS-2012-00309_0001.tif FromACKINNIS ROOFING & SHEET METAL 402 426 2344 10!1612012 09:32 #524 P.002/003
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CITY S. 1 6 TH BLAIR
ST
218 S. 17H STREET
BLAIR, NEBRASKA 66008
"NOT 402 426 - 4191 -Ph- -- 12 LWM Building Permit Application
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& Iset
(402) 426 -4195 - FAX
MS - 2012 - 00309 www,bFalrnebrasxa.urg
08101!2042 MISG Residential October 3, 2012
LOCATIONOFIMPROVEMENT: 1759 Wilbur St, Blair, NB 68008
N ARCHITECT:
GENERAL McKinnis Roofing &Sheet Metal
OWNER: Marc R Gerigk CONTRACTOR: 164 S 1st St
1759 Wilbur St Blair, NS 68008
BLAIR, NE 68008 -0000
400
NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
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PROJECT NAME PERMIT EXPIRES 08101/2014
1T59WiIburSt- 120801 -Roofing ESTIMATED COMPLETION DATE 8/1012012
DESCRIPTION OF WORK
Roofing - Asphalt, Gutters, Fascia, Garage Door and Door Wraps.
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DEPOSIT PAID BY SITE PLAN SUBMITTED: NA
NA
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 Applicant