MS-2014-00989_0001.tif I
CITYOF BLAIR
218 S. 16TH STREET
I
BLAIR, NEBRASKA 68008
Building Permit App lication (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2014 -00989 /Se of ate° www.blairnebraska.org
1 07/0812014 intern MISC Residential July 9, 2014
LOCATIONOFIMPROVEMENT: 1112 Highland Dr, Blair, NE 68008
� ARCHITECT:
� GENERAL. Single Source Remodeling Inc.
® OWNER: Tyler W And Connie Mandarich CONTRACTOR: PO Box 12518
OMAHA, NE 68112
1112 Highland Dr i
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 07/08/2016
1112HighlandDr- 140708 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK j
Reroof, siding, gutters and 4 windows
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
I
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. j
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
uild'ng Off'c' hall constitute sufficient ground for the revocation of any permit issued which was based on the pproval of his
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Date
Signature o ant