445.tif CITYOF BLAIR
m 218 S. 16TH STREET
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BLAIR, NEBRASKA 68008
Building Per Application (402) 426 -4191 - Phone
MS- 2014 -00445 (402) 426 -4195 - FAX
e of a www.blairnebraska.org
06/20/2014 : TM ISC Residential June 20, 2014
LOCATION OF IMPROVEMENT: 922 N 26th Ave, Blair, NE 68008
ARCHITECT:
-.z. GENERAL Donald Andersen
OWNER: Gabriel K And Emily M Petersen CONTRACTOR: 410 Co Rd M
Oakland, NE 68045
922 N 26th Ave
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0611912016
922N26thAve- 140620 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing 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 sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Signatu f Applicant Date