PL-2014-00142_0001.tif CITYOF GLAIR
,'. 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
.1� ° �a,Fj.f,j I�� Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
PL -2014 -00142 ° raise of ado www.blairnebraska.org
04/1412014 PLUMBING Commercial April 14, 2014
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LOCATIONOFIMPROVEMENT: 2028 Kellie St, Blair, NE 68008
ARCHITECT: GENERAL Driver Plumbing
OWNER: Hayden Place Development, Llc CONTRACTOR: 712 12th Ave
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12049 Co Rd P30 COUNCIL BLUFFS, IA 51501
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Sub -Work New Const Primary Commercial- Casey's
PROJECT NAME PERMIT EXPIRES 04/13/2016
2028KellieDr- 131119 -New Commercial 4/14/2016
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Plumbing for new Caseys convenience store and gas. Plumbing for interior only.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
NA
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
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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
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
ap1' afon.
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Sature of Applicant
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