804 (2).tif I
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CITYOF BLAIR
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- 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
y _ _ (402) 426 -4195 -FAX
MS -2014 -00804 aro ma /se of a www.blairnebraska.org I
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07/0212014 MISC Residential July 2, 2014
MW
LOCATION OF IMPROVEMENT: 107 E Riverview Dr, Blair, NE 68008
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ARCHITECT: GENERAL Absolute Roofing
CONTRACTOR:
OWNER: David A And Dawn M Curtis 17330 W Center Rd Ste 110
" OMAHA NE 68130
107 E Riverview Dr
BLAIR, NE 68008 -0000
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IS
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME
PERMIT EXPIRES 07101/2016
107E Rive rviewDr- 140702- 2014Storm ESTIMATED COMPLETION DATE 12/31/2014
Damage
DESCRIPTION OF WORK I
Roofing, gutters, downspout, fascia
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
Y
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 constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signature of Applicant