653_0001 (2).tif i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
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v � (402) 426 -4195 - FAX
MS- 2014 -01132 ise of a www.blairnebraska.org
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07/10/2014 Shelly) MISC Residential July 10, 2014
LOCATION OF IMPROVEMENT: 653 N 10th Ave, Blair, NE 68008
ARCHITECT:
® GENERAL Nebraska Roofing and Drywall
®. OWNER: Chad And Janet Brodersen CONTRACTOR: 6812 Sunshine Dr
OMAHA, NE 68107
IN 653 N 10th Ave
BLAIR, NE 68008 -1341
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 07/09/2016
653N10thAve- 140710 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Reroof and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 co tu sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
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Signature of Applicant Date