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CITYOFBLAIR
J 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426 -4191 -Phone
(402) 426 -4195 - FAX
MS- 2014 -02249 ` °m1. n, Q�° www. blairnebraska.org
08/18/2014 M15C Residential August 18, 2014
LOCATIONOFIMPROVEMENT: 7625 13th St, sta ir, NE 68008
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ARCHITECT: GENERAL McKinnis Roofing & Sheet Metal
Ei. OWNER: Michael D And Pamela S Cushman CONTRACTOR:
164'S 1st St
762 S 13th St Blair, NE 68008
BLAIR, NE 68008.0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/17/2016
762S13thSt- 140818 -2014 Storm. Damage
ESTIMATED COMPLETION .DATE 12/31/2014
DESCRIPTION OF WORK
Roof, siding, paint, gutters, windows
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 its 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 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
app / li aY n.
A r'
Signature of Ap icant Date