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07/1012014 11;05 402 -572 -0154 Page 1/1
Jul, 1%1, 2014 8:32AM CITY Oil BLAIR 402, 426, 41911 Nno, 4 19 1 5 P, 1
CITY OF BLA[R
218 8,16TH S
BLAIR, NEBRASKA 68008 M
B uilding Permit Application (402) 42641 1 - Fens
MS- 2074 01 05'7 ° '�n r 4 ,�*�d' + www.blairnabraska.org
0710 120 4 IVIISG Re July 0, 2014
20" L0CATl0N0FIMPR0VEWNr- 2204 Cedar Cir, Blair, NE 6800E
ARCHITECT:
� GENERAL United Services of America
OWNER_ Scott C And Krystat L Matholan CONT ACT R. $320 N 90th St C
Omaha, Nl; 60134 2264 Cedar fir
BLAIR, NE 60000 -0000
NATURE OF WORK 0 7S CTURE
Storm Repair rmary Residence
PROJECT NAME PERMIT EXPIRES }
2264Ceda 140708 -2094 Storm Damago ESTIMATED COMPLETION DATE 1213112014
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DESCRIPTION OF WORK
Roof, Wiling, gottter-s
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RESchsck/CCIVIchack SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
C
1. No work will be started before a permit is [SSU51) AND POSTED.
2. For commercial permits, a set of plans for thi.3 project mint be submitted to the Nebraska Stato Fire M - arshal's Office for review,
3, Separate permits are required for electrical, plumbing, heating, ventilating and - air conditioning, and septiG system.
4. The undersigned yawner or agent understands and ackrjQ €ledges this building permit application does not constitute issuance Of
this building permit. It is further u nder *tQod that construction covered by this porrniit application shall not be commenced until a
copy of a Permit signed by the Building Inspector is issued.
5 -The undersigned owner or argent agrees to perform the proposed work i n accordance with the specifications set forth above and
in accordance with the codesfordfianci�s of the City of Blair and the State of Nebraska, Any omimlon 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 can the approval of this
application.
7/10/14
Si0natura of Appltcan>t Date
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