MS-2014-01400.tif i
CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008 I
- Building Permit Application (402)426 -4191 - Phone
a r., .° (402) 426 -4196 - FAX
MS-2014-01400 /Se of a� www.blairnebraska.org
0711812014 ShellyJ MISC Residential July 18, 2014
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• m LOCATION OF IMPROVEMENT: 9778 Hwy 75, Blair, NE 68008
ARCHITECT: GENERAL AA Windows N Doors
OWNER: Gary C And Linda, Co- Trustees Asmussen CONTRACTOR: 1304 S Saddle Creek Rd
Omaha, NE 68106
75 9778 Us Hwy
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
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PROJECT NAME PERMIT EXPIRES 0711712016 f
9778Hwy 75- 140718 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK I
Reroof and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 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.
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Signature of Applicant Date
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