SIGNED PERMIT APPLICATION (4).TIF i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application
(402) 426 -4191 - Phone
(402) 426 -4195 -FAX i
ME- 2012 -00553 A`o fi/s e of a ° www.blairnebraska.org
12/0512012 MECHANIC Commercial December 5, 2012
rs LOCATION OF IMPROVEMENT: 2242 Wright St Blair, NE 68008 i
ARCHITECT:
�- GENERAL Ray Martin Co. of Omaha
OWNER: Good Shepherd Lutheran Home CONTRACTOR: 6201 Center St
2242 Wright St Omaha, NE 68106
Blair, NE 68008
1 0
NATURE OF WORK PROPOSED USE
Elect/Mech /Plumbing Nursing Home
PROJECT NAME PERMIT EXPIRES 12/05/2014
2242WrightSt- 120907 - Commercial Remodel ESTIMATED COMPLETION DATE 313012012
DESCRIPTION OF WORK
Install five hydronic fan coil units about 1/2 ton each with heating and cooling
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSITSTATUS: BUILDING PLANS SUBMITTED: NA
N/A
y
I
1. No workwill 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 approval of this
application.
Date
Signature of Applican