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�,. CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA68008
(402) 426-4191 - Phone
Building Permit Application
(402) 426 -4195 •FAX
MS -2014 -00525 Is 01 a www.bla!rnebraska.org
06!24/2014 777MM7 7MISC Residential June 24, 20
LOCATION OFIMPROVEMENT. 1857 Davis Dr, Blair, NE 68008
t ARCHITE=CT:
GENERAL McKi Roofing & Sheet Metal
OWNER: Gordon Jr And Bonnie Larson CONTRACTOR; 164 S 1st St
Blair, NE 68008
1863 Davis Dr
=7 ` BLAIR, NE 68008 -0000
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NATURE OF WORK STRICTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/2312016
1857DavisDr- 140624 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing only
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck 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 Ma r shal'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 j
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app lication.
Date
Signature of A plicant
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