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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
----------------- Building Permit pp cat (402) 426 -4191 - Phone
� a, (402) 426 -4195 - FAX
MS- 2014 -02870 �n,/Se o a www.blairnebraska.org
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09/25/2014 MISC Residential September 25, 2014
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LOCATIONOFIMPROVEMENT: 116 E Riverview Dr, Blair, NE 68008
ARCHITECT:
GENERAL Midwest Exteriors LLC
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0 OWNER: Chad L And Jennifer L Kuchta CONTRACTOR:
13625 C St
116 E Riverview Dr OMAHA, NE 68144
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Structure
PROJECT NAME PERMIT EXPIRES 09124/2016
11 6ERiverviewDr-1 40925-2014 Storm
Damage ESTIMATED COMPLETION DATE 10115/2014
DESCRIPTION OF WORK
Siding and Roofing
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: 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 wito.r without the intention of the undersigned or any alteration or change from this application without approval of the
Buil' id'ng Offi ' I, shall con .titute sufficient ground for the revocation of any permit issued which was based on the approval of this
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Signature of Applicant
Date �
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