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CITYOF BLAIR
218 S. 16TH STREET
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BLAIR, NEBRASKA 68008
B uilding Permit Application (402) 426 -4191 - Phone
a \`� (402) 426 -4195 - FAX
MS -2014 -00905 °wise of a`' www.blairnebraska.org C
0710712014 MISC 7 = Residential r rJurly7,72014 77
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LOCATIONOFIMPROVEMENT: 1965 Grant St, Blair, NE 68008
ARCHITECT:
GENERAL B & G Enterprise
OWNER: Victoria L Herman CONTRACTOR: 1336 Park Ave
OMAHA, NE 68105
1965 Grant St
Milli BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0710612016
1965GrantSt- 140707 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Roof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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
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 ation.
Signature of Applicant Date