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CITYOF BLAIR I
r 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS - 2014 -00628 he of www.blairnebraska.org
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06/2612014 bpeterse MISC Residential July 31, 2014 I
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LOCATION OF IMPROVEMENT: 2017 -2019 South St, Blair, NE 68008
ARCHITECT:
GENERAL Boettcher & Sons Co.
OWNER: Robert L And Ruth E, Trustees Gnuse CONTRACTOR:
434 E 8th St
6515 Co Rd 9 Fremont, NE 68025
ARLINGTON, NE 68002 -5009
INS
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NATURE OF WORK STRUCTURE
Storm Repair Primary residential
PROJECT NAME PERMIT EXPIRES 07/3012016
2017- 2019SouthSt- 140626- 2014Storm ESTIMATED COMPLETION DATE 12/31/2014
Damage
DESCRIPTION OF WORK
Reroof with asphalt shingles, siding on west and north side
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. j
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 Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appl'cat' n.
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Signature of Applicant Date
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