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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
M Building Permit Application (402) 426 -4191 - Phone
9
(402) 426 -4195 - FAX
MS- 2014 -02374 a ` °fi� Ot aJO�� www.blairnebraska.org
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08/2112014 MISC Residential August 21, 2014
� LOCATION OF IMPROVEMENT: 2916 Westridge Dr, Blair, NE 68008
Y ARCHITECT: GENERAL Donald Andersen & Family
OWNER: David C And Lana L Hiller CONTRACTOR:
® 235 S 9th St
2916 Westridge Dr Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/20/2016
2916WestridgeDr- 140821- 2014Storm ESTIMATED COMPLETION DATE 12/3112014
Damage
DESCRIPTION OF WORK
Roof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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 w�ith or without the intention of the undersigned or any alteration or change from this application without approval of the
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B ding Official, shall constitute u icient ground for the revocation of any permit issued which was based on the approval of this
q plication.
Date
Signature of Applicant