MS-2014-00916_0001.tif i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA68008
Building Permit Application (402) 426 -4181 Phone
MS -2Q14 -0091 (402) 426-4195 - FAX
Ise o � a www.bleirnebraska.org
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07/07/2014 MISC Residential July 7, 2014
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LOCATIONOFIMPROVEMENT: 1162 South St, Blair, NE 68008
4t ARCHITECT:
e GENERAL McKinnis Roofing & Sheet Metal
c OWNER: Robert L And Myra Jensen CONTRACTOR: 164 S 1st St
I Blair, NE 68008
1 162 South St
`r! BLAIR, NE 68008 -0000
t • & ir! Via! �, ,� i k l T-
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
P ROJECT NAME PERMIT EXPIRES 07/06/2016
1162SouthSt 140707 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, siding, gutters, garage door
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COM check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
RWI
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
ap ication.
Date
Signature of Applicant