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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
..Bu ilding Permit 11 1 n (402) 426 -4191 - Phone �
(402) 426 -4195 - FAX
RN -2014 -00240 fs of a Ud`` www.blairnebraska.org
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05/20/2014 bpeterse RES -NEW Residential June 18, 2014
LOCATION OF IMPROVEMENT: 10540 Co Rd 26, Blair, NE 68008
ARCHITECT:
r GENERAL Complete Custom Homes
OWNER: Steven G And Alayna M Mentzer Madison CONTRACTOR: 2414 N 175th St
-�� 10168 Margo St OMAHA, NE 68116
LAVISTA, NE 68128 -0000
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NATURE OF WORK PROPOSED USE
New Construction Primary Residence
PROJECT NAME PERMIT EXPIRES 06/17/2016
10540Co Rd 26- 140520 -New Residential
ESTIMATED COMPLETION DATE 12/2012014
DESCRIPTION OF WORK
3 bedroom 3 bath ranch with finished walkout basement, 4 car garage with covered deck on the back. Stick built roof
system.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: Received
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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 withqut intention of the undersigned or any alteration or change from this application without approval of the
Building Off' tal' on trtute sufficient 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