MS-2014-00819_0001.tif i
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding P ermit Application (402) 426 -4191 - Phone
MS -2014 -0 A go o�` (402) 426 -4195 -FAX
rise o+ a www.blairnebraska.org
07/02/2014 MISC Residential July 2, 2014
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LOCATIONOFIMPROVEMENT: 116 S 16th St, Blair, NE 68008
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ARCHITECT.
GENERAL Tolliver Roofing
OWNER: Aaron And Jennifer Belina CONTRACTOR: 9605 Louis Dr
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Omaha, NE 68114
4 116 S 16th St
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Priamry Residence
PROJECT NAME PERMIT EXPIRES 0710112016 j
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116S16thSt- 140702 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
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 ' o the intents o the undersigned or any alteration or change from this application without approval of the
Building O 'cial, all con ' ute s icient ground for the revocation of any permit issued which was based on the approval of this
a licat'
Signature of Applicant Date