2644.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS- 2014 -02644 '0 /Se os a www.blairnebraska.org
09/08/2014 MISC Residential September 8, 2014
LOCATION OF IMPROVEMENT: 1286 Skyline Dr, Blair, NE 68008
ARCHITECT: GENERAL CB Construction
���� OWNER: Donovan L And Kelly R Petersen
CONTRACTOR:
ti ....� 19281 Shadow Ave
MIN
1286 Skyline Dr Honey Creek, IA 51542
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 09/071 2016
1286SkylineDr- 140908 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, 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 accordanc with the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with o ithout the intention of the undersigned or any alteration or change from this application without approval of the
ffiQ al, s all constitute sufficient round for the revocation of an permit issued which was based on the approval of this
Building
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application.
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T Date
Signature of Applicant