533.tif i
Jun 251412;14p Midwest Homes, LLC 4025058265 p.1
CITY OF GLAIR
I 218 S. '16TH STi REET
BLAIR, NEBRASKA 68008
�I "err; "j:: r, ° ° 1l I11 Permit (402) 426 -4191 Phone
(402) 426 -4195 FAX E
www, bl airneb raska. org
06125/2014 [ Mise Residential June 25, 2014
LOCATIC�NOFIMF'ROVEMF_NT: 10281 Crystal Lake Dr, Blair, NE 6$008
wrrE r GENERAL Midwest Homes, LLC
OWNER: Gregor D And Jolene M Kulus c�OtaTRt�GTC�R 10$05 108th St
'Y Weeping Water, NE 68463
10211 Crystal Lake Dr
BLAIR, NE 68008 -0000
. ,K.,W r ~ it s '. •_£ i Ot t Y::".2'„• -..f ..:.j::.,r:c:.�.�i'i: 1r^.C ... ... - .1. Y..�; —_n sa r?:�' �'1 : `4".,j;�:.? %`,'i•- :,if'i"'� f 1ti ::
• ?$'•. :•Cps' `i• •k`'y'. •.�"6:.2yv 1.. ,,�. „ ��`'4: ^, i'! ,:; !�,.�••��rJ .. 3' I }S`rro"�� .S � ^-,, �'3 �r•!•l "14 !\
! {•r r4,:' a }} .,.q°: .1 JcJ:, u•J L•ts:. „ l.) - .n. ..L I,n, �. L. ..r1. `••' ..i . ni
;.{ ..� $. ,L. 'i • � L r•.•....,1.Y �v -'.:. rr ... _- �.t.:r _ C:' }..
NATURE OF WORK STRUCTURE
URE
Storm Repair Primary Residence
PERM EXPIRES 0612412016
PROJECT NAME
I i
10281 Crystal LakeDr-1 40625-2014 Storm ESTIMATED COMPLETION DATE 1213112014
Damage
DESCRIPTION OF WORK
Roogin, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck=Mcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
I
i
• - -.. .iy .rw„ :;Y i•; - : , yr ,.. - :1 . L .. .. �$ s:P .:.'1.8 y '.a r:�•: A,�� '.iy5 :i!3'3?' .�ti -Y'
77
-
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 codestordinances 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
applica '
I
I Date
Signature of Applicant
i