776.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
-4191 - Phone
(402)426
Building Permit Application
(402) 426-4195 - FAX
MS-2014-00776 6e__01 www.blairnebraska.org
2014 MISC Residential July 1, 2014
I LOCATION OFIMPROVEMENT: 1152 Colfax St, Blair, NE 68008
ARCHITECT:
E) GENERAL Ted Dohmen Roofing Inc
OV\NER: Mildred Divoll CONTRACTOR: P.O. Box 4661
OMAHA, NE 68104
5056 S 128th St
OMAHA, NE 68137-0000
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NATURE OF WORK
Storm Repair Pr maryy es ence
PROJECT NAME PERMIT EXPIRES 06/30/2016
1152ColfaxSt-140701-2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Re-doing shingles
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
A MA
1W_ 15A
OR
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 int ntion of the undersigned or any alteration or change from this application without approval of the
Building 0 1 al, shall tute sufficient ground for the revocation of any permit issued which was based on the approval of this
applic * n.
Date
Signature of Applicant