MS-2014-01039.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
t (402) 426.4191 -Phone I
x Building ermi l i cat (402) 426.4195 -FAX
S- 2014 -01039 Q ' ° mrs e o3 U ° www.blairnebraska.org
07109/20'(4
MISC Residential July 9, 2014
LOCAnONOFIMPROVEMENT 918 Flynn Dr, Blair, NE 68008
ARCHITECT GENERAL Titan Exteriors
coNMCTOR:
OWNER. Joel Richard And Mary Jo Ellen Jorgensen 804 S Beadle 5t
PAP> LL(ON, NE 68046
919 Flynn Dr
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PERMIT EXPIRES 07/0812016
PROJECT NAME
919FIynnDr- 140709 -2014 Storm Damage ESTIMATED COMPLETION DATE 71. 912016
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED; NA
1. No work will be started before a permit is ISSUED AND POSTED.
2. For commercial permits, a set of plans for this project most be submitted to the Nebraska Mate 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 shalt 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
applic on r
7/rell 2 c' I
Date
Signatur of Applicant