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CITYOFBLAIR
218 S. 16TH STREET
} BLAIR, NEBRASKA 68008
� l i l€ ��" UIld111 P ermit {402) 426 -4191 - Phone
{402) 426 -4195 -FAX I
IBS -2a'14 -02322 � ° 1 d'� www.blairnebraska.org
I Milli
08/20/2014 MISC Residential August 20, 2014
„ LOCATIONOFIMPROVEMENT: 9851 Pine Crest Rd, Blair, NE 68008
t. ARCHITECT:
GENERAL McKinnis Roofing & Sheet Metal
OWNER: Dale E And Carla L Mc mulien Berg
CONTRACTOR:
q'L 164S 1st St
9851 Pine Crest Rd Blair, NE 68008
BLAIR, NE 68008.0000
. t 3 ?it-: x I
NA OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/1912016
9851 Pine CrestRd- 140820 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12/31/2074
DESCRIPTION OF WORK
Roof, siding, garage doors
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS; BUILDING PLANS SUBMITTED: NA
I
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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app {'cation. j
Signature of Ap /cant Date