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BLAIR, NEBRASKA68008
Bu ild ing Pe rmit Application
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02=014 bpeterse MISC Residential September 23, 2014
LOCATION017IMPROVEMENT: 1005 N 28th Ave, Blair, NE 88008
� ARCHiTECT
GENERAL Absolute Roofing
r
OWNER' Daniel R Broz CONTRA=R.
17580 W Ce nter Rd Ste 11
1200 K+elland Dr OMAHA, NE 88180
NORFOLK, NE 88701 -0000
'CH E
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRE 09121/2016
1005N2$thAve-140$22-2014 storm Damage
ESTIMATED COMPLETION DATE 123112014
DESCRIPTION OF WO
Roofing and Gutters.
DEPOSIT PAID BY; SITE PLAN U13MITTED: NA
Contractor
REScheck/COMeheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS UiI MITTED! NA
1. No work will be started before a permit is ISSUED AND POSTED.
2. Par commercial permits, a set of plans for this project must be submitted to the Nebraska State Fire Ma r shal's Office for review.
B. 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 acco 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 c' , shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicati 1
Ole;
Date
Ignatu Applicant
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