MS-2014-02804.tif i
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS -2014 -02804 a � ° �/S e of av www.blairnebraska.org
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09/1912014 ShellyJ MISC Residential September 19, 2014
LOCATIONOFIMPROVEMENT: 1327 Washington St, Blair, NE 68008
ARCHITECT:
GENERAL Ciaccio Roofing Corp.
a OWNER: Eastern Nebraska Human Services Agency CONTRACTOR:
4420 Izard St
200 7400 Bldg Ste OMAHA, NE 68131
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OMAHA, NE 68114 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 09/18/2016
1327Wash i ngtonSt- 140919 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Reroof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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, II constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signature of pplicant
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