2404.tif E
�`�•.. CITYOF BLAIR
218 S. 16TH STREET
I
BLAIR, NEBRASKA 68008
B uil d ing Pe rmit p(ic N n (402) 426 4191 -Phone
(402) 426 -4195 - FAX
MS•2014 -02404 ran, s �i ago www .blairnebraska.org
08122/014 MISC Residential August 2 2, 2014 71
LOCATIONOFIMPROVEMENT: 1050 N 28th Ave, Blair, NE 68008
t
�It`= ARCHITECT; GENERAL. McKinnis Roofing & Sheet Metal
W OWNER: Christopher A And Letitia S Carlson CONTRACTOR:
164 S 1st St
x- 1050 N 28th Ave Blair, NE 68006
BLAIR, NE 68008 -0000
,r
it
3
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/21/2016
1050N28thAve- 140822 -2014 Storm Damage 12131/2014
ESTIMATED COMPLETION PATE
DESCRIPTION OF WORK
Roof, gutters, siding
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
ap 'cation. �
Date
Signature of Ap icant
i
i
C