MS-2014-01608.tif ^
CITY0FBLAIR
:MD@.16THSTREET
BLA|R, NEBRASKA H0008
(402) 426-4191 - Phone
MOMMN Building Permit App ication
110 www.blairnebraska.org
MS-2014-01608 Ise
7 0 07123/2014 ---- — 7m 1 "7c Residential July 23, 2014
LOCATION OF IMPROVEMENT: 1330 Lincoln St, Blair, NE 68008
OWNER: Francis Carol Hultberg CONTRACTOR: 2211 Peoples Rd Ste B
BELLEVUE, NE 68123
1330 Lincoln St
BLAIR, NE 68008-0000
SW
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 07/2212016
1330LincoInSt-140723-2014 Storm Damage ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Roof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/CO M check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
R
1. No work will be started before n permit is ISSUED AND POSTED.
2. For commercial permito, e net of plans for this project must be submitted to the Nebraska State Fire N1nmhe|'a Office for review.
3. Separate permits are required for electrical, plumbing, heeting, ventilating and air cnnditioning, 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 nhoU not be commenced until a
copy of u permit signed by the Building Inspector is issued.
5. The undersigned owner or agent ognono to perform the proposed work in accordance with the specifications set forth above and
in accordance with the codes/ordinances of the Qty 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 fficial, shall constitute sufficient ground r the revocation of any permit issued which was based on the approval of this
ap�lica' ion.
�� Date mignncum o, Applicant