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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
.rBuilding Permit Application (402) 426 -4191 -Phone
MS -2U'i 4 -U241 �o� �a�``�' (402) 426 -4195 -FAX
ise of a www.blairnebraska.org
08125/2014 MISC Residential August 25, 2014
LOCATION OF IMPROVEMENT: 1063 S 16th Ave, Blair, NE 68008
ARCHITECT: GENERAL Integrity Builders
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OWNER: Michael D And Laura Dunham CONTRACTOR:
416 S 162nd St
` 1063 S 16th Ave Omaha, NE 68118
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/24/2016
1063S16thAve- 140825 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Roof, siding, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RESchecllMcheck 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 with or without the intention of the undersigned or any alteration or change from this application without approval of the
Building O ao -al, s I co -ute su ' 'ent ground for the revocation of any permit issued which was based on the approval of this
app�i, aorni'.
Si 'ature of Applicant Date