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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
MS- 201 - 02682 ����`� (402) 426 -4195 - FAX
/Se of a www.blairnebraska.org
09/10/2014 MISC Residential September 11, 2014
LOCATION OF IMPROVEMENT 1815 Grant St, Blair, NE 68008
4 ARCHITECT: GENERAL Black Bison Contracting
OWNER: Brian S And Barbara A Matzen CONTRACTOR:
®` 1948 Washington St
e � 1815 Grant St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME
PERMIT EXPIRES 09109/2016
1815GrantSt- 140910 -2014 Storm Damage 12/31/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roof, gutters, siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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 cons ti u sufficient ground for the revocation of any permit issued which was based on the approval of this
app cation.
Signature of Applicant Date
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