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CITYOF BLAIR
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218 S. 16TH STREET
BLAIR, NEBRASKA 68008
-4191 Phone
' (402) 426 -
02�� -0 -1- Bu Permit Application
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MS- 2014 -00521 �Q�hiSe of au www.blairnebraska.org
06124/2014 MISC Residential June 24, 2014
LOCATION OFIMPROVEMENT: 11063 Rambleridge Dr, Blair, NE 68008
ARCHITECT:
GENERAL D & M Construction
OWNER: Daniel G And Lori J Falcon CONTRACTOR: 3538 S 48th Ave
OMAHA, NE 68106
11063 Rambleridge Dr
BLAIR, NE 68008 -7562
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/23/2016
11063RambleridgeDr- 140624 -2014 Storm ESTIMATED COMPLETION DATE 12/3112014
Damage
DESCRIPTION OF WORK
Roofing, siding, gutters
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
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 cati n. ,
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Date
Signature of Applicant
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