MS-2014-00719_0001.tif i
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
MS -201 007'19 b10 _ Jo\,��. (402) 426 -4195 - FAX
m /Se of a www.blairnebraska.org
0613012014 intern MISC Residential July 28, 2014 7
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LOCATIONOFIMPROVEMENT: 1973 Crestridge Dr, Blair, NE 68008
ARCHITECT:
F GENERAL CBConstruction
®? OWNER: Archie D And Amy K Dishman CONTRACTOR:
19281 Shadow Ave
1973 Crestridge Dr Honey Creek, IA 51542
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 06/2912016
1973CrestridgeDr- 140630 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12/3112014
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DESCRIPTION OF WORK
Roofing and siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 Offi 'al, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app jcati
Signature of Applicant Date
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