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Jun 27 2014 10 :31 AM HP 4027345550 page 2
CITYOF BLAIR
218 S.1 ST" STREET
BLAIR,NE13RASKA68008
:�� uIldIng Perm Applic (402) 426 -4191 - Phone k
`- Q�4��}�"� r '� (402) 42$ -4185 -FAX
a d� Q www.blairnebmska.org
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061 12612014 NtiSC Residential June 26. 2014
A L.00A'1100FIMPROVE1flENT: 13354 US HWY 30, Blair, NE 68008
ARCHITEC7,
0ENSRA1 Home Pride +Contractors, Inc.
GWNI =R:.
Shane R And Astaisha Masters CONTRACTOR: 5202 1VQ•1 St
y
3013354 Us Hwy Omaha, NE 68117
13LAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES os� 3S12018
1:3354 US H WY 30. 140626 - 2014: Storm
Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION CAP WORK i
Roof only
DEPOSIT PAIQ BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STA 11S: BUILDIN6.PLANS SUBMITTED:
NA
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1. No work will tie started before a permit is ISSUED AND POSTED.
2. For commerciai permits, a set of plans for this project' must be submitted to the Nebraska State Fire Marshal's ice for review.
3. Separate permits are required for.. electrical, piumbing heating, ventilating and air conditioning, and septic system,
4. The undersigned owner or agent understands and dcknowled §es 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 tat perform the proposed work in accordance with the specifications set forth above and
in accordance: with the codes/ordinances of the City 3bf Blair and the State of Nebraska. Any omission of or misrepresentation of �
fact with or ithout the intention of the .undersigned or any alteration or change from this application without approval of the !
Building Official, shall constitute sufficient ground forlhe revocation of any permit issued which was based on the approval of this
app' ti
Signa re of Applicant Date