524.tif CITYOFBLAIR
G 218 S. 16TH STREET
- BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
MS- 2014 -00524 �r (402) 426 -4195 - FAX
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06/24/2014 intern MISC Residential June 26, 2014
LOCATION OF IMPROVEMENT: 1427 Wilbur St, Blair, NE 68008
ARCHITECT:
GENERAL C & S Roofing Inc.
OWNER: Clarence E And Lavaughn Brosam CONTRACTOR: 2211 Peoples Rd Ste B
BELLEVUE, NE 68123
1427 Wilbur St
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/2312016
1427WiIburSt- 140624 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing, siding, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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
Build in Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app[ic tion.
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Signature of Applicant Date j