MS-2014-01955_0001.tif I
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CITYOF BLAIR l
218 S. 16TH STREET �
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
S- 2014 -01955 Ise of a� www.blairnebraska.org
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08/07/2014 ShellyJ MISC Residential August 7, 2014
LOCATION OF IMPROVEMENT: 1643 South St, Blair, NE 68008
ARCHITECT: GENERAL Single Source Remodeling Inc.
OWNER: Larry P And Cynthia A Sorensen CONTRACTOR:
PO Box 12518
41 8632 Co Rd OMAHA, NE 68112
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FT CALHOUN, NE 68023 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 08/06/2016
1643SouthSt- 140807 -2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Reroof, gutters and windows
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
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.
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 f
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
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in accordance with the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of j
fact with or without the intention of the undersigned or any alteration or change from this application without approval of the
Building fficial, shat onstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applic on.
Date
Signa a of Ap licant
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