MS-2014-01072_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
'
Building (402) 426 -4191 -Phone
g Permit Application (402) 426 -4195 -FAX
MS- 2014 -01072 a ' °mrs os www.blairnebraska.org
i
70711012014
MISC Residential July 10, 2014
LOCATIONOFIMPROVEMENT: 636 N 10th Ave, Blair, NE 68008
ARCHITECT: GENERAL First Choice Builders
`
OWNER: Lawrence J And Wanda L Holzer CONTRACTOR: 8909 Bedford Cir #4
OMAHA, NE 68134
636 N 10th Ave
"
BLAIR, NE 68008 -0000
, <,"�''..
STRUCTURE
NATURE OF WORK Primary Residence
Storm Repair
PERMIT EXPIRES 07/09/2016
PROJECT NAME
636N10thAve- 140710 -2 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, gutters, siding
DEPOSIT PAID BY:
SITE PLAN SUBMITTED: NA
Contractor
RESchecklCOMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
r �E -
r-
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
appltio
7 -ly-ly
Date
Si ature of Applicant
r