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CITYOFBLAIR
218 S. 16TH STREET
b BLAIR, NEBRASKA 68008
. B uilding Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS -2014 -02541 A � ° Ise of a� www.blairnebraska.org '
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09/02/2014 Shelly) TM ISC Residential September 2, 2014
®f LOCATION OF IMPROVEMENT: 1109 Jackson St, Blair, NE 68008
ARCHITECT:
GENERAL Barnett Contracting LLC
OWNER: Karen M Camenzind CONTRACTOR:
A ���� 7914 W Dodge Rd #432
1109 Jackson St OMAHA, NE 68114
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 09/01/2016
11 09JacksonSt-1 40902-2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Reroof, siding and gutters
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`
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�Sinature
Date
of Applicant
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