851.tif CITYOFBLAIR
218 S. 16TH STREET
BLAiR
rt
, NEBR 68008
1 Applicat (402) 426 -4191 -Phone
Bu ild i n g (402) 426 -4195 - FAX
MS- 2014 - www.blairnebraska.org
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07(0312014 MI SG Residential July 3, 2014
LOCATION OF IMPROVEMENT: 800 N 14th Ave, Blair, NE 68008
ARCH ILCT: GENERAL Husker Siding & Windows, Inc.
OWNER. _ Lorraine Peterson CONTRACTOR: 1406 Veterans Or
Elkhorn, NE 68022
800 N 14th ,Ave
BLAIR, NE 68008 -0000
NATURE OF WORK STRICTURE
Storm Repair Primary Residence
PERMIT EXPIRES 0710212016
PROJECT NAME
800 N14thAve- 140703-2014 Storm Damage ESTIMATED COMPLETION DANE 12/ 31/2014
DESCRIPTION OF WORK
Asphalt roofing
DEPOSIT PAID BY: SITE FLAN 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 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
J fficial, shall const itute sufficient ground for the revocation of any permit issued which was based on the approval of this
.
Date
Spplicant