2494.tif I
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CITYOF BLAIR
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218 S. 16TH STREET
BLAIR, NEBRASKA 68008
CI If1 i Applica (402) 426 -4191 - Phone
UII
(402) 426 -4195 - FAX
S- 2014 -02494 Ise of aid\` www.blairnebraska.org
08127/2014 MISC Residential August 27, 2014
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� LOCATION OF IMPROVEMENT: 1031 N 28th St, Blair, NE 68008
ARCHITECT:
GENERAL Triton Exteriors Inc
CONTRACTOR:
OWNER: Dawn M Mcgauley
1121 Bluebill Blvd
1031 N 28th St Buffalo, MN 55313
" BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/2612016
1031 N28thSt- 140827 -2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /C0Mcheck 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
f w' r without the intention of the undersigned or any alteration or change from this application without approval of the
Building Officia , all constit a sufficient ground for the revocation of any permit issued which was based on the approval of this
is o
Date
Si atu f Applicant