Signature page_0001-1.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
- Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
PL- 2012 -0 /se of QJ� www.blairnebraska.org
10/22/2012 PLUMBING Residential October 22, 2012
LOCATION OF IMPROVEMENT: 959 Southfork Rd, Blair, NE 68008
ARCHITECT:
GENERAL CNJ Plumbing Inc
n OWNER: Merle R And Lori L Mallette Hansen Hanse i CONTRACTOR: 1665 State St
2254 Hollow Rd Blair, NE 68008
GLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
Sub -Work New Const Primary Residence -Condo
PROJECT NAME PERMIT EXPIRES 10/22/2014
945- 959SouthforkRd- 110420 -New ESTIMATED COMPLETION DATE 12/31/2012
Residential -Condo
DESCRIPTION OF WORK
Plumbing for 945 side. 3 bathroom, kitchen, laundry tray, drain and groundwork
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
a + + ® + ° • Ism
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 fficial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app /' ti n: ff
Date
Signature of Applicant