SIGNED PERMIT APPLICATION (2).TIF CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
tt Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
MS- 2012 -00501 ° m4e of Q° www.blairnebraska.org
11/02/2012 MISC Residential November2, 2012
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LOCATIONOFIMPROVEMENT: 1067 Jackson St, Blair, NE 68008
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ARCHITECT: GENERAL SELF
5 OWNER: Chad And Amy Larsen CONTRACTOR:
1067 Jackson St Blair, NE 68008 j
w = BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Fence Fence
PROJECT NAME PERMIT EXPIRES 11/0212014
1067JacksonSt- 121102 -Fence ESTIMATED COMPLETION DATE 11/30/2012
DESCRIPTION OF WORK
4' Chain Link fence in rear of property.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Held
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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 pprovaI of this
application.
Date
Signature of A nt
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