MS-2014-02480.tif i
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CITYOF BLAIR j
218 S. 16TH STREET r
BLAIR, NEBRASKA 68008 j
v ulling eri Application (402) 426 -4191 -Phone
MS 2014 - 02480 (402) 426 -4195 - FAX
/s o f a� www.blairnebraska.org E
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08/26/2014 Shelly) MISC 77 M Residential August 26, 2014
A LOCATION OF IMPROVEMENT: 2215 Hollow Rd, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Jacque A Belles CONTRACTOR:
2215 Hollow Rd Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 0812512016
2215HoIlowRd- 140826 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Re- siding on North and West side only
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 j
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.
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Sig n ture of Applicant Date