MS-2014-01747_0001.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
®W "„ Building Permit App lication (402) 426 -4191 -Phone
9 (402) 426 -4195
MS- 2014 -01 -FAX
/Se o+ a www.blairnebraska.org
07129/2014 MISC Residential July 29, 2014
LOCATIONOFIMPROVEMENT: 1433 Park St, Blair, NE 68008
r ARCHITECT:
® GENERAL SELF
OWNER: Cathy L Williamsen CONTRACTOR:
1433 Park St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
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PROJECT NAME
PERMIT EXPIRES 07/2812016
1433ParkSt- 140729 -2014 Storm Damage ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Shingles, siding
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
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 wit or without the intention of the undersigned or any alteration or change from this application without approval of the
Build' Offic' I, shall on titute sufficient ground for the revocation of any permit issued which was based o the approval of this
ap ; 'ca
Signature of scant
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