MS-2014-01169_0001.tif ,16TH 5'�EET
BLAIR- NEBRASKA C8008
Pormit Application �4ri ?p A7F. IQI a }a,�n�
VS (402) 42G.4195 - FAX
arav�or.IaJaira� etar.��Y;�,�r
Q��111t201�t I�9il�� .��id�nlial �luly 1
L ' . b,Sar= aFlPPi't a irtlf;
1256 Adlairi - St. Blair, NE 6800a -T
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` alloy Boars, Inc.
Monte R And Julie M Fly iti 105-47 Bo tdesson Cie
Omaha, NE ry-G122
1256 Ad;5unq St
BLAIR, NE 68DO f OOD
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NATURE OF WORK STRUCTURE
Storm Repair i Primary Rezirderace
PROJECT NAME PERMIT EXPIRES 07110Y2016
125GAdaert59t 44711L2014 Starm Damage
ESTIMATED COMPLETION DATE 12131f2014
DESCRIPTION OF WORK
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Roof
DEPOSIT PAID BY SITE PLAN SUBMITTED-. NA
Con tractor
RES6h pk==check SUBMITTED Fwd
JSE P 05 IT ST TUS:
BUILDING PLANS S1 BMITTW; INA
777 `
1. No work 'Will bo tMarted befoje a purardit is 1SS(IF-L) AND PGSTF1j
2, For cornrrpr6al permit-., a yet of plans for this parclert must be sub ittad to the Nebr ckco Stitt Fire Office for re'vieai.
3. Separate penr7its urn: required for raloatrical, plumbintl,, t'inling, ventifwing rind air cnnditioMing, and s:apVc t: Aurn.
4, The uridon igned a,+drr - aer or ugent undr-Tsla ds and ackn rvilodgus thi_� budding pencdt arplic aalion does not Constitute f- ssiaance of
this building peTmit, it is Further un clorstood that c caves -sl icy ti`s perm - jit ��ppjl sa- C n i,,Natl not be commenctmi u nil a
ropy of a Nevcnst :=fgncd by the Building Insperlo is i; darsd.
-Thp uanfta i rw -J ay. -ner r)r za�urrl agreed M porforrat the prz posed work in aciyjrdonce. with the, specifications ations c N' forth �laoue anti
in acairdance Nvith the ewdo&ordinance� ail' 1W City of Shir° grtei line State of Nobrijuka. Any w i;;;ion of or n*, ro*cn afmn o
fact witl) or v 11ap, intention of the ka« 4rtigned or ;5r - jp lturadon or chzitxju from this zippli don vvithovt �ipprorval of tl•ie
Buildint3 OFF" 1, Sham c6.mAituto sufficient �llaa and for the rew vatiurt of any r5ea`tn t issued whirl - 1 vdtw' based on tho appTuval of this
;3f piiir�t rasa.
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.� 71 F It P
Signature of . pplioafid —_ Mne
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