1075_0001.tif CITYOF BLAIR
q a 218 S. 16TH STREET (
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BLAIR, NEBRASKA 68008
Building 1" I Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
S -2014 -00314 I a of o� www.blairnebraska.org
06/12/2014 MISC Residential June 12, 2014
-- LOCATION OFIMPROVEMENT: 1075 N 14th St, Blair, NE 68008
ARCHITECT: GENERAL The Roofing Moose
OWNER: Lynn Renee Hagedorn CONTRACTOR: 20164 Husker Dr
1075 N 14th St GRETNA, NE 68028
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 06/11/2016
1075N14thSt- 140612 -Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Replacing roof, siding, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
plication. Ll
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Date
Signature of Applicant