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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
a ~� (402) 426 -4195 -FAX
of
MS -2014 - 00971 ° � / www.blairnebraska.org
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0 7 MISC Residential July 8, 2014
." LOCATIONOFIMPROVEMENT: 1728 Colfax St, Blair, NE 68008
ARCHITECT: GENERAL D & M Construction
w OVVNER: Robert C Sr And Myra M Larsen CONTRACTOR: 3538 S 48th Ave
OMAHA, NE 68106
1728 Colfax St
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0710712016
1728ColfaxSt- 140708 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, siding, gutters, windows
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/C0Mcheck SUBMITTED: 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 ith or without the intention of the ndersigned or any alteration or change from this application without approval of the
B ildi Official, shall constitute suffic' nt ground for the revocation of any permit issued which was based on the approval of this
plic ion.
Date
i nature of Appl cant j
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