2162.tif C
CITYOF BLAIR
t 218 S. 16TH STREET
BLAIR, NEB RASKA 68 008 1
Building Permit Application (40 426 - 4191 Phone
MS -2 014 -02162 (4 he 01 � ° �``,r ww,blai nebraska or
08/1412014 MISC Residential August 14, 2014 f
.; t.00ATIONOFIMPROVEMENT: 2239 Jackson St, Blair, NE 68008
i ARCHITECT.
GENERAL Mc Kinnis Roofing & Sheet Metal
-i'� OWNER: Matthew L And Sarah J Marymee Petersen CONTRACTOR:
7
164 S 1st St
2239 Jackson St Blair, NE 68008
BLAIR, NE 68008 -1111
NATURE OF WOR STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08 1 13/2016
2239JacksonSt- 140814 -2414 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, gutters
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.
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
appli ation.
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Signature of App cant Date
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