456.tif I I
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CITYOFBLAIR
218 S.16TH STREET
BLAIR, NEBRASKA 68008
B uilding Permit
(402) 426 - 419'1 - Phone
a, r�= (402) 426 -4195 -1=/�X
M S-2014-00456 °m se o, a www.blairnebraska..org
1 11 ONE
intern MISC Residential June 20, 20'14
06/2012014 �
LOCATION OFIMPROVEMF_NT: 8$74 Co Rd P33, Blair, NE 6$00$
ARCHITECT: GENERAL BradCo dba Total Roofing Company
OWNER: Jerry & Rebecca Fox CONTRACTOR: 10501 Chandler Cir Rm 100
LAVISTA, NE 68128
1669 Washington St
Blair, NE 68008
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
J CT NAB PERM EXPIRES 06 119120'16
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8874Co Rd P33 - 140620 -2014 Storm Damage 1213112014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roofing and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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 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
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Signature of Applicant Dat
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