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Jun 2b 14 Ob'49a p''
C#' OFBLAIR j
218 S,18TH STREET j
NLAIR, NEBRASKA68OD3
Building Porrmit Application JA02) 42&4191 - Phone
t4v"o (402) 4n.4195 - FAX
MS- 2014MOO493 tir ox, www.bi$irr+eE raska.cw9
4612312014 Residential June 24, 2014
LocATIONOFIW tR JBrAE]NT; J543 South :fit, Flair, NE 60008
Gam. lager Siding Company
CVMER Ruby J Harn CONTRACTOR 120 N Mahn St
Louisville, NE 88087
1543 South -St
BLAIR. ME 58008.0000
NATUM OF 'WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES
15421SoathSt- 1411623 2014 Storm damaije
ESTIMATED COMPLETION ELATE 1213112014
DESCRIPTION OF WORK
Ise -mof only
DEPOSIT PAID BY: SITE PLAN 311.1113MIT'TEd; NA
CD"IYarltar
REBcheeklCOMeheck SiaBMI717TED: NA
DEPOSIT STATI,I$: BUILDING PLANS SUBMITTED: NA
$60
1. No work will Fie ataErted before o "rmit Is ISSUED AND POSTED.
2. For curnmerCiat permits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Ofrice for review
$. Separate, permits are required for electrical, plumbing, heating ventilating and air conditioning, and septic system.
4.7he undersigned owner or agent understands and aanowledges this building permit application does not constituto Issuance of
this building permit. It is further understood that carrstruc:tion covered by this permit epplicatlon shall not be commenced until e
copy of a permit signed by the Building Inspector is issued,
5. The undersigned owner w agent agrees to perform the proposed work in arCordanW with the specifloations set forth above and
in accordance wM the codestordinances of the pity of Blair and the State of Nebraska. Any orrrission of or misrepresentation of
faot with or without the intention of the and"gned or any eltemtlon or change from this applicafloh without approval of the
Building yptciial, shall constitute sufficient ground for the revocation of any permit Issued which was based on the approval of thin
appiica
Sianshim err Annlirant
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