2507.tif i
CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
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Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS- 2014 -02507 p � ° Ise of ag www.blairnebraska.org
08/2812014 � LMISC Residential August 28, 2014
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;d LOCATION OF IMPROVEMENT: 11634 Cord 27, Blair, NE 68008
ARCHITECT:
GENERAL Bennett Construction
OWNER:
Thomas I And Marilyn J Urwin CONTRACTOR:
205 Main St
27 11634 Co Rd Kennard, NE 68034
� BLAIR, NE 68008 -0000
Adam
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 08/27/2016
11634Cord 27- 140828 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Roof, presidentials
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
5
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
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