543.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
�� ��.:��� � Building Permit Application (402) 426 -4191 - Phone
FAX
MS -2014 -00543 a wwww.blai nebraska or f
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06/25/2014 MISC Residential June 25, 2014
LOCATION OF IMPROVEMENT: 1141 Nebraska St, Blair, NE 68008
ARCHITECT:
GENERAL A - 1 Home Restoration
- OWNER: Ronald D Hansen CONTRACTOR: 4705 N 96 St
OMAHA, NE 68134
41 8934 Co Rd
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/24/2016
1141 NebraskaSt- 140625 -2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roofing, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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 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 w9 the es /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or w intention of the undersigned or any alteration or change from this application without approval of the
Building Off' i h 11 nst' .uffic e t ground for the revocation of any permit issued which was based on the approval of this
applicatio r
Signat a of Applicant Date
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