MS-2014-00296.tif i
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CiTYOFBLAIR
218 S.16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application
(402) 426 -4181 - Phone
(402) 426 -4185 - FAX �
MS -2014 -00296 Ar °��e� AS qil� www;blaimebraska.org
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0611012014 M18C Residential June 10, 2014
x LOCATIONORMPROVEMENT: 912 Meadow Dr, Blair, NC 68008
ARCHITECT: GENERAL The Roofing Moose
OWNER: Roxanne M Smith CONTRACTOR: 20164 Husker Dr
3 912 Meadow Dr GRETNA, NE 68028
BLAIR,NE 68008 «0000
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NATURE OF WORK PROPOSED USE
Primary residential
Storm Repair
PERMIT EXPIRES 0
PROJECT NAME �
912MeadowDr- 140610 -2014 Storm Damage ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Roof, gutters, siding, windows
DEPOSIT PAID BY SITE PLAN SUBMITTED: NA
Contractor
REScheck1COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
IRAN= MOOSE 11 5
.,
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
application.
Date
Signature of Applicant
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CITY OF BLAIR, NEBRASKA
Phone 402 - 426 -4191
RECEIVEDOR f
ADDRESS J� 1
CITY, STATE, ZIP CODE
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THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
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RECEIVED BY
Pounds Printing, Blair, NE 68008
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