481_0001.tif I
CITYOF BLAIR
µ 218 S. 16TH STREET
A pplication NEBRASKA 68008
�r
Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2014 -00481 lO M/Se of a°° www.blairnebraska.org
06123/2014 MISC Residential June 23, 2014
LOCATIONCIFIMPROVEMENT: 1513 Oak Dr, Blair, NE 68008
ARCHITECT: GENERAL Mercury Contractors, Inc.
OWNER: Marie And Daniel E Shumake Adams CONTRACTOR: 4222 Davenport
Blair, NE 68008 �
1513 Oak Dr ,
BLAIR, NE 68008 -0000
2 :. t
NATURE OF WORK
STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0612212016
15130akDr- 140623 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Roofing, gutters, windows, siding, deck, painting
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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 or without the intention of the undersigned or any alteration or change from this application without approval of the
Building O ial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicatio
Signature of Applicant Date