PERMIT APPLICATION (6).TIF I
CITY OF BLAIR
f -t 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Y Building Permit Application
(402) 4264191
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(402) 426 -4195 -FAX �
MS- 2012 -00514 94' �m /so 0SeQ� ° www. blairnebraska.org
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11/0812012
brwheele MISG Residential November14,2012
LOCATiONOFiMPROVEMENT: 910 Skyline Dr, Blair, NE 68008
s ARCHITECT: GENERAL McKinnis Roofing & Sheet Metal
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OWNER S And Donna J Mahlendorf C ONTRACTOR:
® � 164 S 1st St
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910 Skyline Dr Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /SoffiVEaves /Gutters Primary Structure
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PERMIT EXPIRES 11/14/2014
PROJECT NAME
910SkylneDr- 121108 - Roofing ESTIMATED COMPLETION DATE 11130/2012
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DESCRIPTION OF WORK j
One layer tear off - replace with asphalt
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA �
Contractor
RESCheck/COMcheckSUBMITTED: NA
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DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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1, No work will be started before a permit is ISSUED AND POSTED. f
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.
6.The undersigned owner or agent agrees to perform the proposed work in accordance with the specifications set forth above and 9
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 Officlal, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
placation.
Date
Signa ure ofA ficant