1087_0001.tif E
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
A WHO B uilding Permit Application
(402 426 -4191 -Phone
9 (402) 426 -4195 - FAX
MS -2014 -00313 °�nrs of a� °'' www.blairnebraska.org
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06/12/2014 MISC Residential June 12, 2014
A� LOCATIONOFIMPROVEMENT: 1087 Skyline Dr, Blair, NE 68008
ARCHITECT: GENERAL The Roofing Moose I
OWNER: Jeffrey S And Darla A Zurek CONTRACTOR: 20164 Husker Dr
1087 Skyline Dr GRETNA, NE 68028
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 06111/2016
1087SkylineDr- 140612 -2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Replacing roofing, siding, gutters,
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck 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.
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
B ' ding- Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applic on.�'
Signs � oppflcant Date