MS-2014-0265.tif i
09/03/2014 WED 18:42 FAX 0 002 /004
i
Sep. 1 2014 5, 05PM CITY OF BLAIP (402.426.4191) Klo. 4964 P, 4
CITY05 BLAIR
218 6.16TN STREET
BLAIR, NEBMSKA68008
U
i ld - Int P e rmit A (402) 426 -4181 - Phone
CIS- ��a�4y02�8� (402 426-4196 - FAX
www1 iairnebraska.0ril
11 MI
09/03/2014 Shelly) MISC Residential September $ , 201 1
A LOOATiONOFIMFROVEMENT: 1330 5 16th St, Blair, NE 68008
® ARCHITECT:
} GENlrM F16 Caritracting
OWNER Robert: And Linda Kiesfer CONTRACTOR:
324 S 13th St
1330 S 16th St Tokamah, NE 58061
BLAIR, NE 68008 -0000
IN III Hill
MOONS
INS
NATURE OF WORK STRUCT
Storm Repair Primary
PROJECT DAME PERMIT EXPIRES 09/0212016
1330S16that- 140903 -2014 Storm Damage ESTIMATED COMPLETION CRATE 1213112014
DF$CRIPTION OF WORK
Reroof, siding and gutters
01;POSIT PAID ICY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/00i check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$54
1. No work will be started before a permit is ISSUED AND POSTED,
2. For commercial permits, a se# of plans for this protect must be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical, plumbing, heating, ventilatfng 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.
S. The undersigned owner or argent 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 co stitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicafio
Signature F Applicant Ia�9
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