453.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
a: = i'rlg Permit A pplication (402) 2s 191 -Phone
B uild
y ��a (402) 426 -4195 -FAX I
VIS- 2014 -00453 Are /so of a���` k www.blairnebraska.org
)6/20/2014
MISC Residential June 20, 2014
LOCATIoNOAMPROVEMENT: 1070 N 28th Ave, Blai , NE 68008
ARCHITECT:
® GENERAL Home Pride Contractors, Inc.
® OWNER: Randall Harold And Connie Jo Rasm ss CONTRACTOR: 5202 "0" St
Omaha, NE 68117
1070 N 28th Ave
B LAI R, NE 68008 -1023
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NATURE OF WORK STRUCTURE I
Storm Repair Primary Residence
PROJECT NAME
PERMIT EXPIRES 06/1912016
1070N28thAve- 140620 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, siding, and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
1
Contractor
RESchecklOMcheck SUBMITTED: 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 gust be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical, plumbing, f eating, 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 con ruction covered by this permit application shall not be commenced until a
copy of a permit signed by the Building Inspector is isst"ed.
5. The undersigned owner or agent agrees to perform th" proposed work in accordance with the specifications set forth above and
in accordance with the -lodes /ordinances of the City 9 Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or �vjfhi 6 t he intention of the undersigned br any alteration or change from this application without approval of the
Build ing..ffici'al. shall constitute sufficient ground for 'Ae
C� revocation of any permit issued which was based on the approval of this
� l
application,�'�
Dat -- - �
'Ignaturef Applicant
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