MS-2014-02535.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
" ® - � b � • ����� (402) 426 -4195 -FAX
MS -2014 -02535 rO �iSe o1 Qv0 www.blairnebraska.org
09102/2014 ShellyJ MISC Residential September 2, 2014
LOCATIONOFIMPROVEMENT: 2116 Park St, Blair, NE 68008
ARCHITECT:
GENERAL Royalty Roofing
OWNER: Kelley J And Ashley R Halsey CONTRACTOR:
3519 N 53rd St
2116 Park St OMAHA, NE 68104
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 09/0112016
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2116ParkSt- 140902 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Reroof, siding, gutters and windows
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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 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 j'alention of the un igned o Vy alteration or change from this application without approval of the
Buildin ftucial shall o stitute sufficien ro d for -the r� vocation of any permit issued which was based on the approval of this
applic tion:
Date
Signature of Applicant