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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
�� �� 94 Building Permit Application (402) 426 -4191 -Phone
a „u (402) 426 -4195 - FAX
MS-2014-00422 Ise of aka www.blairnebraska.org
06/19/2014 MISC Residential June 19, 2014
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LOCATION OF IMPROVEMENT: 950 N 14th St, Blair, NE 68008
� s ARCHITECT:
GENERAL The Roofing Moose
OWNER: Jeff M And Penny L Kment CONTRACTOR: 20164 Husker Dr
r GRETNA, NE 68028
950 N 14th St
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/18/2016
950N14thSt- 140619 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing, siding, gutters, fencing,
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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 wit wit ut the intention of the undersigned or any alteration or change from this application without approval of the
Buil i Ig Official shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
a licatio .
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Date
Signature of Apk nt
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