499.tif G
i
C ITY OF BLAIR
!r <= ~ 218 S.16TH STREET
BLAIR,NEBRASKA68008
Building Permit Application (402) 4 - Phone
4 26 (402)426 -4195 -FAX
MS- 2014 -00499 x! + ,., www.hlairnebraska.arg
E June 0612412014 intern MISC Residential
24, 2014
LOCATIONORMPROVEMENT: 1212 Corey Dr, Blair, NS 68008
ARCHITECT: GENERAL Hometown Roofing, Inc.
�a OMER: Kim A And Brenda M Quick CONTF' ACTOR: 13316 Millard Ave
Omaha, NE 68137
1212 Corey Dr
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storrs Repair Primary Residence
PROJECT NAME PERMIT EMPIRES 06123/2016
1212CoreyDr- 140624 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Re -roof and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
1
a
i
I .
7' -
1. No workwill 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 Mate 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 codeslordinances 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
applicat' n.
A 7
z_J Li Date
Signature of Applicant
T abed ZS T iP9131320i: XUA 13CNEISY1 dH WIjSE s 01 ip i 0;3 irk unC