845.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Build Permit App (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS - 2014 - 0045 ���'�se of au www.blairnebraska.org
07/0312014 MISC Residential July 3, 2014
b LOCATION OF IMPROVEMENT: 977 N 25th Ave, Blair, NE 68008
ARCHITECT:
w GENERAL Buckshot Exteriors
a OWNER: Van Nimwegen, James C and Adeline CONTRACTOR: 4622 S 85th St
OMAHA, NE 68127
977 N 25th Ave
BLAIR, NE 68008 -0000
e i
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PERMIT EXPIRE 07/02/2016
P ROJECT NAME
977N25thAve- 140703 -2014 Storm Damage ES TI M ATE D COMPLETIO DATE 12131/2014
DESCRIPTION OF WORK
Roofing
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 codeslordinances 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
appl' 'on, Iq
Dat
Signature of A10licant