PL-2013-00138_0001.tif i
CITYOF BLAIR
218 S. 16TH STREET
t ° BLAIR, NEBRASKA 68008
(402) 426 -4191 - Phone
wilding Permit Application
(402) 426 -4195 - FAX
PL -2013 -00138 Al �mise o , a� ° www.blairnebraska.org
05103/2013 bpeterse PLUMBING Residential May 3, 2013
7 ,.,% � LOCATION OF IMPROVEMENT: 848 N 11th St, Blair, NE 68008
' ARCHITECT: GENERAL Boruff Plumbing
w� OWNER: Na Bank Of America CONTRACTOR: 412 N 5th St
7105 Corporate Dr Missouri Valley, IA 51555
'I X 75024 -0000
PLANO,
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NATURE OF WORK PROPOSED USE
Sub -Work New Const Primary Residence
PERMIT EXPIRES 05103/2015
PROJECT NAME
848N11thSt- 130312- Residential Remodel ESTIMATED COMPLETION DATE 5/3/2015
DESCRIPTION OF WORK
Plumbing for Habitat House.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
NA
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
r rr�
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 const' ute sufficient ground for the revocation of any permit issued which was based on the approval of this
appli ation.
-17
Date
Si natur of Applicant