Application (3).tif I
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CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426-41x1- P hone
MS- 2014 -01449 a10 0��`,} (402) 426 -4195 - FAX
mdse of q www.blairnebraska.org
07118/2014 MISC Residential July 18, 2014
LOCATIONOFIMPROVEMENT: 863 N 10th St, Blair, NE 68008
ARCHITECT:
GENERAL Exterior Remodel and Design
V OWNER: Justin And Angela Burbeck CONTRACTOR: 14225 Dayton Cir
OMAHA, NE 68137
863 N 10th St
x BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 07117/2016
863N10thSt- 140718 -2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
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DESCRIPTION OF WORK
Roof, siding, windows
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
M011101-0 W
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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 t t tention of the undersigned or any alteration or change from this application without approval of the
Building icial, all onstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appliq tion.
Sig ture o pp cant Date