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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
UII Ill @I"11"ll IICc�tl11 (402) 426 -4191 - Phone
- ��- r'�,�� (402) 426 -4195 - FAX
MS- 2014 - 00316 °�� of q� www.blairnebraska.org
IN
06/12/2014 MISC Residential June 12, 2014
LOCATIONOFIMPROVEMENT: 568 S 23rd St, Blair, NE 68008
E ARCHITECT: GENERAL The Roofing Moose
� OWNER: Pamela S Coppock CONTRACTOR: 20164 Husker Dr
568 S 23rd St GRETNA, NE 68028
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BLAIR, NE 68008 -0000
NATURE OF WORK PROPOSED USE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 06/11/2016
568S23rdSt- 140612 -Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Replacing roof, steel 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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application. )0
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Signature of Applicant Date
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