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CITYOF BLAIR !
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218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
MS- 2014 -00366 °wise of Qua www.blairnebraska.org
06/16/2014 brwheele MISC 77777 Residential June 16, 2014
LOCATION OF IMPROVEMENT: 1748 Butler St, Blair, NE 68008
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ARCHITECT:
GENERAL Black Bison Contracting
OWNER: Daniel L And Cheryl L Penner CONTRACTOR: 1948 Washington St
1748 Butler St Blair, NE 68008
BLAIR, NE 68008 -0000
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11 id NATURE OF WORK PROPOSED USE
Storm Repair Primary Structure
PROJECT NAME PERMIT EXPIRES 06/15/2016
1748ButlerSt- 140616 -2014 Storm Damage ESTIMATED COMPLETION DATE 911/2014
DESCRIPTION OF WORK
one layer tear off, replace asphalt, siding and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RES check/CO Mcheck 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 suffici ground for the revocation of any permit issued which was based on the approval of this
application.
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Date
Signature of Applicant