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CITYOF BLAIR E
218 S. 16TH STREET
BLAIR, NEBRASKA 68008 G
ate- (402) 426 -4191 - Phone
BUilding Permit Application
(402) 426 -4195 -FAX
MS- 2014 -00415 Ise o ,
www.blairnebraska.org
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06119/2014 MISC Residential June 19, 2014 j
LOCATIONOFIMPROVEMENT: 810 -950 Southfork Rd, Blair, NE 68008
®.� ARCHITECT: GENERAL C & S Roofing Inc.
OWNER: Southfork Homeowners Association c/o Jim CONTRACTOR: 2211 Peoples Rd Ste B
a Cook BELLEVUE, NE 68123
920 Southfork Rd
Blair, NE 68008
a
NATURE OF WORK STRUCTURE
Storm Repair Unit containing 810, 820
PROJECT NAME PERMIT EXPIRES 0611812016
E
810- 950SouthforkRd- 140619- 2014 Storm ESTIMATED COMPLETION DATE 1213112014 I
Damage
DESCRIPTION OF WORK
Reroof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck 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 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
Buildi Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app tion.
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Si Date
nature of Applicant