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cITYOF BLAIR �
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
��.'� i111� 7i'l,77 -77 �
B I Application (402) 4264191 Phone
(40 426 -4195 - FAX
MS- 2014.02353 `°mr� of a�b wvvw. blairnebraska.org
012112D14 M1SC Residential August 21, 2014
LOCATION OF IMPROVEMENT: 2142 Lincoln St, Blair, NE 68008
ARCHITECT:
GENERAL McKinnis Roofing & Sheet Metal
OWNER Doris J Cooksey CONTRACTOR:
` 164 S 1st St
2142 Lincoln St Blair, NE 68008
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
I
PROJECT NAME
PERMIT EXPIRES 0812012016
2142LincoinSt- 140821 -2014 Storm Damage ESTIMATED COMP DATE 1213112014
DESCRIPTION OF WORK
Roof, siding, gutters
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
application.
Signature of Ap licant Date
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