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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
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B Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS - 2014 -00736 iseot a� www.blairnebraska.org
06/3012014 MISC Residential June 30, 2014
� LOCATIONOFIMPROVEMENT: 1139 Corey Dr, Blair, NE 68008
ARCHITECT.
- - GENERAL AGR Group
OV\NER: William Curtis And Michele C Dean CONTRACTOR: 348 N 76 St
-� OMAHA, NE 68114
1139 Corey Dr
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06129/2016
1139CoreyDr- 140630 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Shingles, guttersn siding, windows, screens
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
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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 I
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 intentio of the undersigned or any alteration or change from this application without approval of the
Building Offici , hall constitut 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
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