MS-2014-01436_0001.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application
(402) 426 -4191 - Phone
� (402) 426 -4195 - FAX
MS-2014 -01436 ise of a o www.blairne'braska.org
07/18/2014 MISC Residential July 18, 2014
LOCATIONOFIMPROVEMENT: 776 N 15th St, Blair, NE 68008 j
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ARCHITECT: I
GENERAL Joe Goeden Construction
y® OWNER: Richard A And Myrna E Vercruysse CONTRACTOR: 1150 N 252nd St
WATERLOO, NE 68069
15954 Co Rd P10
BLAIR, NE 68008 -0000
7 77 Erf 'fi r `:•- tom`,- .. -....� Sv�w ;: s., r' . ,��rd�., `t- '�_��'`��� , ,.�Z � a `w : /' � y; � " � � G �". �,. - _3 ,-y . � " �rx z s� ., ;
, �T;_ '_,- .�. -..w t a=z �.' - . , ��,-,. ,.����';',+�'��,.,.��-�z�z���,v r,..��`���� .-u�r ._.;.�.��..,?.-, ; RE OF WORK STRUCTURE
Repair Primary Residence
CT NAME PERMIT EXPIRES 07/17/2016
776N1 5thSt-1 40718-2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
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Contractor j
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
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
Build in cial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applic tion. °)
Date
Signature of A licant j
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