MS-2014-01143_0001.tif i
CITYOFBLAIR
r t.) 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
_ 402 4
26 4191 -Phone
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Buildin Permit Application I
{402) 426 -4155 -FAX
MS- , A � � www.blairnebraska.org
Ji 111
07111/2014 MISC Residential July 11, 2014
LOCATIONOEIMPROVEMENT: 279 N 22nd St, Blair, NE 68008
ARCHrrECT' GENERAL Husker Siding & Windows, Inc.
OWNER: Cindy L Montez CONTRACTOR: 1406 Veterans Dr
Elkhorn, NE 68022
279 N 22nd St
GLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 07/1012016
279N22ndSt- 140711 -2414 Storm Damage ESTIMATED COMPLETION DATE
12/31!2014
DESCRIPTION OF WORK
Roof, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
P
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
Bull ing
Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ppfcation.
Sign re of Applicant Date