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-� CITY OF BLAIR
/ 218 S. 16TH STREET
BLAIR,NEBRASKA68008
l�ll 1 �" App lication (402)426- 4'191 -Phone I
r
N1S -2014- 02(189 (4 oz) 426 -4195 -FAX
�'` °�„ p www.blairnebraska.org
08111/2014 MISG Residential August 11, 2014
LOCATIONOFIMPROVEMENT 1221 S kyli ne Dr, Blair, NE 68008
i ARCHITECT:
GENERAL McKinnis Roofing & Sheet Metal
OWNER David A And Harriet 4 Waite CONTRACTOR:
164 S 1st 5t
1221 Skyline Dr Blair, NE 68008
BL,AIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAIVE PERMIT EXPIRES 0811012016
1221SkylineDr- 140811 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Roof, gutters, siding, doors
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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.
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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 codeslordinances 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 lication.
Signature of ppiicant Date
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