ME201200488APPLICATION.TIF i
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CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Bu Pe rmit {402)426- 4191 -Phone
(402) 426 -4195 - FAX
-201 - 004$ "� s e �� t J� \ www.blairnebraska.org
10/25/2012
MECHANIC Commercial October 25, 2012
{ LOCATION OF IMPROVEMENT: 245 S 22nd St, Blair, NE 68008
' ' ARCHITECT:
GENERAL Ray Martin Co. of Omaha
OWNER: Crowell Memorial Home CONTRACTOR: 6201 Center St
245 S 22nd St Omaha, NE 68106
. , . BLAIR, NE 68008 -0000
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,�€*''r n �•c ' c y •st / � � ',. ,: �t "'�S •£� 2 "x ��x` 1?r `� � ���',. '�rtq 5 lire
NA TURE OF WORK PROPOSED USE
Misc. Permit Primary
PRO JE C T l PERM EXPIRES 10/2512014
245S22ndSt- 121025 -- Mechanical ES TIMATE D COM PLE TION DATE 12/3112012
DESCRIPTION OF WORK
Replace Boilers- 2 @100,00 - 300,000; 1@ 500,000
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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 onstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applic ti
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Date
Signature of Applicant