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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
- � = Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
MS- 2014 -01985 of www.blairnebraska.org
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08108/2014 MISC Residential August 8, 2014
LOCATION OF IMPROVEMENT: 2016 Wright St, Blair, NE 68008
� ARCHITECT:
a
GENERAL Triton Exterior
s OWNER: Cathy L Williamsen CONTRACTOR:
1625 N 203rd St
1433 Park St ELKHORN, NE 68022
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/07/2016
2016WrightSt- 140808 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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. j
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
Buil g Offcia hall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap i n. _
Da e
Signa ure of 4plicant
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