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CITYOF BLAIR
° 218 S. 16TH STREET
- BLAIR, NEBRASKA 68008
�� � .,...... m Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
MS- 2014 -01210 0- Se of aJ °�ti www.blairnebraska.org
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07/14/2014
MISC Residential July 14, 2014
LOCATION OF IMPROVEMENT: 1518 Park St, Blair, NE 68008
ARCHITECT:
GENERAL Royalty Roofing
CONTRACTOR;
OWNER: Steven V And Lori J Halsey 3519 N 53rd St
OMAHA, NE 68104
1518 Park St
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PERMIT EXPIRES 07/13/2016
PROJECT NAME
1518ParkSt- 140714 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, siding, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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 f
fact with or w' hout the intention of the undersigned or any alteration or change from this application without approval of the
Building Off' i shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appli a io
Date
Signature of Applicant
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