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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4196 - FAX
MS -2014 -00777 fi of a� www.blairnebraska.org
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[07/01/2014 MISC Residential July 1, 2014
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. LOCATIONOFIMPROVEMENT: 2053 Nebraska St, Blair, NE 68008
v ARCHITECT:
GENERAL Ted Dohmen Roofing Inc
OWNER: 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 STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0613012016
2053NebraskaSt- 140701 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Re -roof with asphalt shingles
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
1
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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 application without approval of the
Building Official, shall co stitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signat re of A plicant