760.tif I
CITYOFBLAIR
J 218 S. 16TH STREET
( ! BL.AIR, NEBRASKA 68008
Application
t4o2� 4z6 -a��1- Phone
B uilding
(402) 426 -4195 .. FAX
MS - 2014 -00760 ° m/se 01 Q'' www.blairnebraska.org
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07l01i2�1 MISC Residential July 1, 2414
LOCATIONOFIMPROVEMENT: 11025 Co Rd P29, Blair, NE 68008
ARCHfTECT: GENERAL McKinnis Roofing & Sheet Metal
_ OWNER: Randall D Quick
164. S 1st St
i � Blair, NE 68 008
11025 Co Rd P29
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06130!2016
11025C Rd P29- 140701 -Storm Damage ESTIMATED COMPLETION BATE 12131!2014
DESCRIPTION OF WORK
Roofing and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: 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 with the codes /ordinances of the City of glair 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 constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application. l
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Signature of Appt✓ cant Date