MS-2014-01574_0001.tif t. CITYOF BLAIR i
i) 218S.16THSTREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 4264191 - Phone
y , (402) 4264195 - FAX
MS-2014- ` www.blairnebraska.org
0712312014 MISD Residential July 23, 2014
LOCATIONOEIMPROVEMENT 1067 Westridge Dr, Blair, NE 6800$
ARCHITECT:
GENERAL Husker Siding & Windows, Inc.
OWNER• Richard A And Cynthia J Roenigk CONTR4CTOR; 1406 Veterans Dr j
t ; Elkhorn, NE 68022
1067 Westridge Dr
BLAIR, NE 68008-0000
' 7 r
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
I
PERMIT EXPIRES 0712212016 j
PROJECT ;,NAME
1067WestridgeDr- 140723 -2014 Storm ESTIMATED COMPLETION DATE 12/31/2014
Damage
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck1COMcheck SUBMITTED: NA
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
B ` ding Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
a lication.
Date
Si ature of Applicant
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