MS-2014-00295.tif i
01TYOF BLAI
218 S.16TH STREET
BLAIR, NEBRASKA 68008
B uilding Permit Ap
(4021 426- 4191 - =h,n i
(402) 426-4196 - FAX
MSm2014-0029
tifo` b www.blai nebraska org
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06/1012014 MISC Residential June 10, 2014
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LOCATIONOFIMPROV'EMENT: 970 N 14th St, Blair, NE 68008
e ARCHITECT: GENERAL The Roofing Moose
a OWNER: Terence C And Kathryn A Doll CONTRACTOR: 20164 Husker Dr
970 N 14th St GRETNA, NE 68028
° BLAIR,NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Storm Repair Primary residential
PROJECT NAME PERMIT EXPIRES 06/0912016
970N14thst- 140610 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112014
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DESCRIPTION OF WORK
Roof, gutters, windows
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
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Contractor
REScheckICOMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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.
6. 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
application.
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Signature of Applicant
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CITY OF BLAI. R, NEBRASKA
Phone 402 - 426 -4191
RECEIVED OF
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ADDRESS
CITY, STATE ZIP CODE
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THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
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RECEIVED BY
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Pounds Printing, Blair, NE 68008
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