MS-2014-02502.tif I
I
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
r (402) 426 -4191 -Phone
B uilding Permit Application
(402) 426 -4195 - FAX
MS- 2014 -02502 04 se of QJa\` www.biairnebraska.org
08/28/2014 7 ShellyJ MISC Residential August 28, 2014
• LOCATION OF IMPROVEMENT: 1236 Jackson St, Blair, NE 68008
ARCHITECT:
GENERAL Donald Andersen & Family
O WNER: Michael R And Joann M Dodd CONTRACTOR:
235 S 9th St
1236 Jackson St Blair, NE 68008
BLAIR, NE 68008 -0000
u
NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 08/2712016
1236JacksonSt- 140828 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Reroof, gutters and siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
FAM
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 th intent' a undersigned or any alteration or change from this application without approval of the
Buildin ial, sh II nsti to suffic' nt ground for the revocation of any permit issued which was based on the approval of this
a pl' '
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114 V/
Signa ure of Applicant Date