MS-2014-02704_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
uilding Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS - 2014 -02704 lse 01 a ° ° � www.blairnebraska.org
09/11/2014 bpeterse MISC Residential September 11, 2014
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LOCATION OF IMPROVEMENT. 637 N 11th St, Blair, NE 68008
ARCHITECT:
GENERAL Schafersman Construction LLC
OWNER: Jeffrey J And Sherone L Stork CONTRACTOR:
�f PO Box 605
13009 Co Rd P11 Arlington, NE 68002
ARLINGTON, NE 68002 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 09/10/2016
637N11thSt- 140911 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK j
Re- roofing.
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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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Signature of Applicant Date