1303.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
m ��.n Building Permit Application (402) 42s -4191 -Phone
(402) 426 -4195 - FAX
MS -2014 -01303 ;Se °, a� www.blairnebraska.org
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07116/2014 MISC Residential July 16, 2014
f •� LOCATIONOFIMPROVEMENT: 11348 Rambleridge Dr, Blair, NE 68008
� y ARCHITECT: �
GENERAL Quality First Roofing, Inc.
OV\NER: Nathan A And Reita D Larsen CONTRACTOR: 3716 D St
OMAHA, NE 68107
11348 Rambleridge Dr
BLAIR, NE 68008 -0000
OF
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0711512016
11348RambleridgeDr- 140716 -2014 Storm 12/31/2014
Damage ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roof, siding, windows, screens
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.
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 i tention of the undersigned or any alteration or change from this application without approval of the
Buildi i 1, s II c stitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap ica
Ph
Date
Signature of Ap cant
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