Permit Application (10).tif i
I
CITYOF BLAIR
w 218 S.16TH STREET
BLAIR, NEBRASKA 68008
(402) 426 -4191 - Phone
Building Pe r it Ap p li ca ti on (402) 426 -4195 -FAX
www.blairnebraska.org
MS- 2014 -00991 /Se o,
07/08/2014 intern
MISC Residential July 9, 2014
w
d LOCATIONOFIMPROVEMENT: 745 N 15th St, Blair, NE 68008
t' ARCHITECT: GENERAL Joe Goeden Construction
OWNER: Derek L And Jasmyn L Johnson CONTRACTOR: 1150 N 252nd St
WATERLOO, NE 68069
745 N 15th St
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Primary
Storm Repair
PERMIT EXPIRES 07/08/2016
PROJECT NAME
745N15thSt- 140708 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Reroof, siding, windows and gutters
DEPOSIT PAID BY:
SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
�.- wv
1. No work will be started before a permit is ISSUED AND POSTED. bmitted to the Nebraska State Fire Marshal's Office for review.
2. For commercial permits, a set of plans for this project must be s
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 applicatio
shall not no t
be n ommenced ance a
this building permit. It is further understood that construction covered by this permit app
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 pecificati or s e t forth a a of
in accordance with the codes /ordinances of the City of Blair and the State of Nebraska. y omission o f
fact with or without the intention of the undersigned or any alteration or change from app without
based on the approval of his
Building Official, shall constitute sufficient ground for the revocation of any permit issued
applic o OL
Date
Signature of pplicant