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CITYOF BLAIR
218 S. 16TH STREET j
BLAIR, NEBRASKA 68008
B uilding Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX j
MS- 2014 -00270 /Se of a www.blairnebraska.org
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[06/0612014 MISC Residential June 11, 2014
LOCATIONOFIMPROVEMENT: 1457 Butler St, Blair, NE 68008
ARCHITECT:
�'� ' GENERAL SELF
OWNER: Elizabeth Ann .
CONTRACTOR:
1457 Butler St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 06/0512016
1457ButierSt- 140606 -2014 Storm Damage 8/6/2014
ESTIMATED COMPLETION DATE j
DESCRIPTION OF WORK
Re- roofing with asphalt shingles, Vinyl siding replacement and window replacement.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COM check 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. j
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.
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