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CITYOFBLAIR I
218 8,16 HSTREET E
B NEBRASKA 69006
L�,IE�, �E 1
(402) 426 -4191 > Phone
.. •. �,� � . ,..� . . . �� B P ermi t Appli {4432] 426-4195 » FAX
a 1 m 2 r° ise of a `' °`� www.blairnebraska.org
4391221014 bpeterse M! SC Residehtial S 23 , 201
LOCA110NO FIMPROVEMEfiliM. 1170 Voss Ci r, B lair, NE 66006
ARCHrMc GENERAL D rey Inc,
WMER Raymond K And Janet S, Trustees Lush Cott rRP.CTOR:
6606 Wirt St
1170 Voss Cir Omaha, NE 66134
BLA IR, NE 63008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PRO JECT PERM EXPIRES 09/2112016
1170VossCir- 10g -0 S torm Dama
ESTIMA L TI ON DA TE 1213112014
DESCR
Re -roof and Gutters
DEPOSIT PAID Y: SITE PLAN SUBMITTED: NA
Contractor
REScheck/CC check SUBMITTED: NA
DEPOSIT 'S'TATUS; B UILDING PLAN 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 permi 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 wilding Inspector is issued,
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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 constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
plication.
Signa d re of Applicant Date