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CITY`OF BLAIR
218 S. 16TH STREET
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BLAIR, NEBRASKA 68008
Budding Permit Application (4 02) 426 -4191 - Phone ,
A� �� (402) 426 -4195 - FAX
MS-2014-00462 d��s� os a`' www .blairnebraska.org
06/20/2014 MISC Residential ,June 20, 2014
LOCATIONOFIMPROVEMENT: 13075 Prairie Grass Ln Blair NE 68008
�. ARCHITECT:
GENERAL
Pyramid Roofing
OWNER: Leo Charles And Michelle A L uetticke CONTRACTOR: 1504 S Saddlecreek Rd
Omaha, NE 68106
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13075 Prairie Grass Ln
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' BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/1912016
13075Prairie GrassLn- 140620 -1
ESTIMATED COMPLETION DATE 12131/2
DESCRIPTION OF WORK
Roofing only
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck 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
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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 c , n titute sufficient ground for the revocation of any permit issued which was based on the approval of this
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Signature of Applicant r' e.r Date