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CITYOF BLAIR
218 S. 16TH STREET
r BLAIR, NEBRASKA 68008
Building Permit Application (402)426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2014 - 00518' °am www.blairnebraska.org
01 06/24/2014 intern MISC Resi June 25, 2014
LOCATION OF IMPROVEMENT: 1027 N 18th Ave, Blair, NE 68000
ARCHITECT
GENERAL Husker Roofing, Siding & Gutters
OMER. Frank W And Kristi M Jacobs CONTRACTOR: 9001 Arbor St
OMAHA, NE 68124
505 Cherry Hills LrI
FT CALHOUN, NE 68023 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06123/2016
1027N18thAve- 140624 -2014 Storm. Damage
ESTIMATES COMPLETION DATE 12131/2014
DESCRIPTION of WORK
Re -roof, siding, windows
DEPOSIT PAID BY SITE FLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED. NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED, NA
$50
Y
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
Buil Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
a' li `on.
Signa a of Applicant _ Date