Signature page_0001-4.tif i
C
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
402 426 -4191- Phone
III i Application ( >
(402) 426 -4195 -FAX I
ME- 2012 -00525 ar ��ise of aJa\\ www.blairnebraska.org
i
Shell J MECHANIC Residential November 13, 2012
11/13/2012 Y �
i
LOCATION OF IMPROVEMENT: 150 S 11th St, Blair, NE 68008
ARCHITECT:
GENERAL BLT
OWNER: Marsha Ann Ruwe CONTRACTOR: 1010 Broad St S
I
® 14 17614 Co Rd FREMONT, NE 68025
BLAIR, NE 68008 -0000
x s
t"
.�.,,. a -c �. — M om r ,-� : _� .'-" ......, �� -,,.,, ., .. r.
, -=- r � �',.� .''-r' -.. N
- �. „..r- r ..x.,
�r=- 2��`��
a? .�,. -> u.. .......a! - �..., -,. .,.: -. .. ... � .:.,�s- =...:. ”- ,a -.:..: ✓' �, w . ,�.., ,z .... .,:;� :,-., -,,. , .- ::,. -..-..
�,... --.-te . rY "'' {� �" � �,,,, T'"r;.'
. ". r: -vet .,r ...- ,�......, .�-. ..✓.,r,!..�.., . '�°,m'',..- ,.,....3 -° ,.-,,, .:. .r,.,�:�. `"`�= � ,�^'. -
NATURE OF WORK PROPOSED USE
Elect /Mech /Plumbing Primary Residence
PROJECT NAME PERMIT EXPIRES 11/13/2014
150S11thSt- 121113- Mechanical ESTIMATED COMPLETION DATE 11/13/2012 ti r C
DESCRIPTION OF WORK
75,000 BTU furnace replacement
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
d s
I
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
I
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 -
C