420 (2).tif i
CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Budding Permit Application (402) 426 -4191 - Phone
v 1 44 (402) 426 -4195 - FAX
MS -2014 -00420 /Se of aJ�\` www.blairnebraska.org
06119/2014 MISC Residential June 19, 2014
d� LOCATION OF IMPROVEMENT: 810 -950 Southfork Rd, Blair, NE 68008
ARCHITECT:
�� GENERAL C & S Roofing Inc.
X OWNER: Southfork Homeowners Association c/o Jim CONTRACTOR: 2211 Peoples Rd Ste B
Cook BELLEVUE, NE 68123
920 Southfork Rd
Blair, NE 68008
MR
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NATURE OF WORK STRUCTURE
Storm Repair Unit containing 910, 920, 940, 950
PROJECT NAME PERMIT EXPIRES 06/18/2016
810- 950SouthforkRd- 140619 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Reroof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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 o without the intention of the undersigned or any alteration or change from this application without approval of the
Building icial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicati n.
Signature of Applicant Date