signature page_0001 (3).tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
(402) I Application (402) 426 -4191 - Phone
9 ti �a (402) 426 -4195 - FAX
P - 2014 - 00152 fiIseo+ a� www.blairnebraska.org I
04115/2014 POLEBARN Residential April 15, 2014
LOCATION OF IMPROVEMENT: 12868 Co Rd 30, Blair, NE 68008
® ARCHITECT: GENERAL SELF
8 ®f OWNER: Mitchell And Stacy Barney CONTRACTOR:
2020 Hickory Blair, NE 68008
DAKOTA CITY, NE 68731 -0000
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NATURE OF WORK PROPOSED USE
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New Construction Accessory Structure
PROJECT NA
PERMIT EXPIRES 04114/2016
12868 Co Rd 30- 131105 -New Residential 5/31/2014
STIMT D COMPLETION DATE
DESCRIPTION OF WORK
48 x 32 Pole Barn - Electrical for lighting only - Dirt Floot
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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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 j
in accordance with the codeslordinances 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.
Signature Applicant Date