ME-2013-00110.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
lllldlll Permit Application (402) 426 -4191 - Phone
ME- 2013 - 00'1'10 '0'0 Jo\`l�t (402) 426 - 4195 - FAX
m6 of a www.blairnebraska.org
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04/15/2013 ShellyJ MECHANIC Residential April 15, 2013
LOCATIONOFIMPROVEMENT: 947 Pheasant Cir, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Donald C And Neva G Adamson CONTRACTOR:
428 El Cerrito Way Blair, NE 68008
" GILROY, CA 95020 -0000
NATURE OF WORK PROPOSED USE
New Construction Primary residence
PROJECT NAME
PERMIT EXPIRES 04115/2015
947PheasantCir- 130123 -New Residential
ESTIMATED COMPLETION DATE 4/15/2013
DESCRIPTION OF WORK
Duct work, 100,000BTU furnace, 3 bath vents, 3.5 ton A/C
j
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
r
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 approval of this
application.
Date
Signature of All pp sc