MS-2014-01634_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS -2014 -01634 A10 he Of a
7 �7
07124/2014 MISC Residential July 24, 2014
°d LOCATIONOFIMPROVEMENT: 13412 Cord 16, Blair, NE 68008
ARCHITECT: GENERAL Jorgensen Contracting, Inc.
N OWNER: A Philip And Florence L Larsen CONTRACTOR:
` 530 Front St
16 13412 Co Rd Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 07123/2016
13412Cord 16- 140724 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112014
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DESCRIPTION OF WORK
Roof on long gable building
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. j
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
uil ing Official, shall constitute sufficient u "nd or the revo tion of any permit issued which was based on the approval of this
ap icatio
gna a of Applicant Date