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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
°9WBuilding Permit Application (402 ) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2014 - 01884 se of a�° www.blairnebraska.org
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0810412014 MISC Residential August 4, 2014
_ LOCATION OF IMPROVEMENT: 1663 Washington St, Blair, NE 68008
,ARCHITECT: GENERAL Goslin Contracting Inc.
OWNER: Melinda K Rump CONTRACTOR:
6116 Military Ave
1663 Washington St OMAHA, NE 68104
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 08103/2016
1663WashingtonSt- 140804- 2014Strorm ESTIMATED COMPLETION DATE 12/3112014
Damage
DESCRIPTION OF WORK
Flat roof replacement, and sign repair
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: 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
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.
Date
Signature of Applicant