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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
II 1 Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
S -2014 -02134 > of au °° www.blairnebraska.org
08/13/2014 MISC Residential August 13, 2014
LOCATION OF IMPROVEMENT: 1014 N 28th Ave, Blair, NE 68008
ARCHITECT:
GENERAL Warrick Construction Co.
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OWNER: David L And Crystal L Zima CONTRACTOR:
1114 James Dr
21 12652 Co Rd Blair, NE 68008
BLAIR, NE 68008 -5600 t
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NATURE OF WORK STRUCTURE
Siding Primary Structure
PROJECT NAME PERM EXPIRES 0811212016
1014N28thAve- 140813 -2014 Storm Damage ESTIMATED CO DATE 8/3112014
DESCRIPTION OF WORK
Siding on west and north
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheckSUBMITTED: 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
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 ith or without t e intention of the undersigned or any alteration or change from this application without approval of the
Buildi g Official, shall onstitute suffi ' nt ground for the revocation of any permit issued which was based on the approval of this
appli ation.�
Date
Signature of Applicant
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