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CITY OF BLAIR I
� 218 S. 16TH STREET C
BLAIR, NEBRASKA 68008
(402) 426 -4191 -Phone {
Building Permit Application
(402) 426 -4195 -FAX
MSi -2014 -00451 lO fiise of Q www.bl ai rnebraska.org
0612012014 MISC Residential June 2 20 14
LOCATIONOFIMPROVEMENT: 2255 South St Blair, NE 68008
ARCHITECT: GENERAL BradCo dba Total Roofing Company
OWNER: Hinke J And Jarod Jensen Troost CONTRACTOR: 10501 Chandler Cir R m 100
LAVISTA, NE 68128
2255 South St
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE j
Storm Repair Primary Residence
PROJECT NAME P ERMIT EXPIRES 0611912016
2255SouthSt- 140620 -2014 Storm Damage 12131/2014
ESTIM COMPLETION DATE
DESCRIPTION OF WOR
R and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RESchecklCOMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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.
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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 Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application,
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Signature of Applicant U Da
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