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CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
U ng GYI111t App Ica ion
(402) 426 -4191 -Phone
• �,_ (402) 426 -4195 -FAX
MS- 2014 -00603 of a � www.blairnebraska.org
06/26/2014 MISC Residential June 26, 2014
LOCATIONOFIMPROVEMENT: 2831 Westridge Dr, Blair, NE 68008
® ARCHITECT: GENERAL Absolute Roofing
G' OWNER: Mike L And Lori A Bensen CONTRACTOR: 17330 W Center Rd Ste 110
OMAHA, NE 68130
2831 Westridge Dr
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/2512016
2831WestridgeDr- 140626- 2014 Storm ESTIMATED COMPLETION DATE 12131/2014
Damage
DESCRIPTION OF WORK
Re- roofing and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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 applic:atiun 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
application. yy}
Date
Signature of Applicant