MS-2014-02539.tif i
CITYOFBLAiR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
U1 ng Permit Application (402) 426 -4 191 - Phone
= MS-201 �° °� { �.b rues "Fax
0�5�9 n„ �t �a raska,org
09/0212014 SheilyJ MISC Residential Se ptem ber 2,2014"
LOCA11ONOFIMPROVEMENT: 9978 teak V alley Rd, Blair, NE 68008 ;
r ARCHiTECT:
GENERA. Husker Siding & Windows, Inc.
r C M ER: Cameron D And Jill G Dodds CONTRACTOR.
1406 Veterans Dr
9678 Oak Valley Rd Elkhorn, NE 68022
BLAiR, NE 68008.0000
NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 09/0112016
96780ak VaIleyRd- 140902W2014 Storm
Damage ESTIMATED COMPLETION DATE 12/3112014
(DESCRIPTION OF WORK
Reroof
DEPOSIT PAID BY: SITE PLAN SUBMITTED. NA
Contractor
REScheck/COMcheckSUBMiTTED: NA
DEPOSIT STATUS:
BUiL,DING PLANS SUBMITTED: NA
$b0
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 pe 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,
6 -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 hall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
licatlon
Signature a Appiicant Gaga
i