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r CITYOFBLAIR
218 S.16TH STREET
`y BLAIR, NEBRASKA 68008
Building Permit Application ( 40 2) 426.4191- Phone
'�� ��� (402) 426.4'1 - FAX
Iui5�2o'14 -003 2 °fi s0 ct ai www.blaimebraska.org
0611712014 MISC Residential June 17, 2014
• 1 LOCATION OF IMPROVEMENT 13092 Us Hwy 30, Blair, NE 58008
D ARCHITECT, GENERAL Pyramid Roofing
tip» OWNER Donna J And John M Co- Trustees Henton CONTRACTOR. 1504 S Saddlecreek Rd
£� 3013092 Us Hwy Omaha, NE 68106
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 06116/2016
13492Us Hwy 30- 140617 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Remove and replace roof, gutters, and siding
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.
C. 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.
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L ature of Applicant 0 to