584.tif CITYOF BLAIR
218 S. 16TH STREET
im
BLAIR, NEBRASKA 68008
11
Building 1 Application (402) 426 -4191 - Phone
a� (402) 426 -4195 - FAX
MS- 2014-00584 �n of a www.blalrnebraska.org
06/2612014 MISC Residential June 26, 2014
a LOCATION OF IMPROVEMENT: 1067 Jackson St, Blair, NE 68008
ARCHITECT: GENERAL Lastime Roofing /Guttering /Awning
vas ' OWNER: Chad And Amy Larsen CONTRACTOR: 8901 Maple St
Omaha, NE 68134
v.: 1067 Jackson St
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAM E PE RM IT EXPIRES 06/2512016
1067JacksonSt- 140626 -2014 Storm Damage
ES TIMATED COMPLETION DATE 12/31/2014
DESCRIPTION O WORK
Re -roof, gutters, gagrage doors, windows
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 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.
n
ti
Date
Signature of Applicant