MS-2014-01352_0001 (2).tif i
CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
MS- 2014 -01352 °'off o��`�� (402) 426 -4195 - FAX
Is os a www.blairnebraska.org
07/17/2014 MISC Residential July 17, 2014
LOCATIONOFIMPROVEMENT: 1928 Colfax St, Blair, NE 68008
v ARCHITECT: GENERAL Hoffman Weber Construction Inc
®_ OWNER: Van Slyke, Thomas S and Janice j CONTRACTOR: 3515 48th Ave N
MINNEAPOLIS, MN 55429
- 1941 Soren Dr
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME
PERMIT EXPIRES 07116/2016
1928ColfaxSt- 140717 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
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DESCRIPTION OF WORK
Roof, siding
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
R EScheck/CO M check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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- 11 :-
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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
M � � v `� 7/19/14 I,
Signature of Applicant Date
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