MS-2013-00473-1.tif CITYOF BLAIR
218 S. 16TH STREET
� BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
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( 402 ) 426 -4195 - FAX
w ww . blairnebraska.or g
ka.or
MS- 2013 - 00473 p ' °"Ilse °, oi- g
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10/1112013 ShellyJ MISC Residential October 11, 2013
LOCATIONOFIMPROVEMENT: 735 N 3rd St, Blair, NE 68008
r " ARCHITECT:
GENERAL SELF
OWNER: Teresa A Plamondon CONTRACTOR;
735 N 3rd St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary
PROJECT NAME PERMIT EXPIRES 10111/2015
735N3rdSt-1 31011 -Roofing 10/18/2013
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Tearing off one layer and replacing with asphalt shingles
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Teresa Plamondon
REScheck/COMcheck SU WITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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1. No work will be started before a permit is ISSUED AND POSTED.
2. For commercial rmits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
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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
ap lication.
Date
Signature of Applicant
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