872 per.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS- 2014 -00329 is of au www.blairnebraska.org
06/13/2014 7MISC Residential June 13, 2014
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LOCATIONOFIMPROVEMENT: 872 S 16th St, Blair, NE 68008
ARCHITECT:
GENERAL Jim La Hood Construction, Inc.
o1NNER: Joel E And Donna R White CONTRACTOR: 802 S. 50th Ave
872 S 16th St Omaha, NE 68106
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 0611212016
872S16thSt- 140613 -Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Replacing the roof
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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N^ IME f
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
Buil ing Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app - ation. r
Date
Sign ure of Applic t