MS-2014-01771_0001.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
(402) 426-4191 - Phone
Building Permit Application - FAX
(402) 426-4195
MS-2014-01771 0 /S 01 www.blairnebraska.org
Residential July 30, 2014
07/30/2014 :F� IS
LOCATION OFIMPROVEMENT: 3052 Anderson Dr, Blair, NE 68008
ARCHITECT:
GENERAL Bennett Construction
OVVNER: Richard D And Sandra Mohler CONTRACTOR:
205 Main St
3052 Anderson Dr Kennard, NE 68039
BLAIR, NE 68008-0000
IN
M�1111N RO 11ft".
NO
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 07/29/2016
3052AndersonDr-I 40730-2014 Storm ESTIMATED COMPLETION DATE 1213112014
Damage
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
NO
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 revie
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 ot
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.
Date
Signature of Applicant