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OrrYOFBLAIP.
2188.*16THSTREET
BLAIR, NEBRASKA68008
(402) 426 -Phone
Building Permit Application (402) 426A196 - FAX
MS-2014-00286 www.blairnebranka.org
06110120114 IShellyJ misc Residential June 10, 201•
• LOCATIONOFIMPROVEMENT1. 1046 Jackson St, Blair, NE 68008
ARCH ff EM- GENERAL Asper) Exteriors Inc
OMER Donna Lange CONTMTM •4245 St Francis 131vd 101
1046 Jackson St rarnsey, IVIN 6003
SLAIR, NE 66006.0000
NATURE OF WORK PROPOSED USE
Ro ofin ghsoffltmaveslo utters Primary
PR0J9CT NAME PERMIT EXPIRES 0610912016
1040acksonSt-14061 0-Storna Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Roofing
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RESchook/003VIcheek SUBMITTED; NA
DEPOSIT STATUS,. BUILDING PLANS SUBMITT1510: NA
$60
ArFADA
VT OVA
1. No work will be started before a permit is ieSUEDAND POSTED.
2, For commerViod permits, a set of plans for this pro)aot 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 ogent understands and acknowledges this building permit application does not constitute Issuance of
this bullding 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 Insplactor Is Issued.
15. The undersigned owner or agent agrees to parform the proposed work In accordance with the specifications set forth above and
In s000rdanoe With the codeslordinancer, 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 Offo constitute officlent ground for the revocation of any permit Issued which was based on the approval of this
n.
Signature4of Applice*nl' data