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218 S.16TH STREET C
BL.AIR, NEBRASKA 68008
u ildin Perm ( 426.4191 P hone
(402) 426 4198 - FAX
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08/06!2014 MISG Residential August 5, 2014
LOCAnONORMPROVEMEN'r: 1518 Nebraska St, Blair, NE 68008
ARCHITECT:
GENERAL McCoy Roofing, Siding & Contracting
OWNER: Layton D And Betty L Anderson CONTRACTOR:
1 12901 Lakeview Dr
1618 Nebraska 5t SPRINGFIELD, NE 58069
BLAIR, NE 66008.0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 061 .
1618Neb 140805.2014 Storm Damage ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Reroof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck1COM+check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$60
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
apollcation.
Date
Signature of Applicant
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