MS-2014-2656.tif CITYOF BLAIR
218 S. 16TH STREET
'
BLAIR, NEBRASKA 68008
Building Permit App lication (402) 426 -4191 -Phone
9 (402) 426 -4195 - FAX
MS- 2014 -02656 a10 /Se 01 a� www.blairnebraska.org
M ill 111 111:
09109/2014 ShellyJ MISC Residential September 9, 2014
LOCATIONOFIMPROVEMENT: 716 N 11th St, Blair, NE 68008
ARCHITECT:
GENERAL . SELF
OWNER: Christopher C And Jill M Jensen CONTRACTOR:
716 N 11th St Blair, NE 68008
BLAIR, NE 68008 -0000
7
.,
NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 09108/2016
716N11thSt- 140909 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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 aq6ordance with the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact it r wit t the intention of the undersigned or any alteration or change from this application without approval of the
B u infficia all constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
app ica
Signatu e o Applic t Date