2888.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
MS- 2014 - 02888 b � ° �;se of a� °�� www.blairnebraska.org
09/26/2014 bpeterse MISC 777 0 7 Residential September 26, 2014
LOCATION OF IMPROVEMENT: 200 Hollostone Dr, Blair, NE 68008
ARCHITECT: GENERAL SELF
OWNER: Waylon James & Wright CONTRACTOR:
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200 Hollostone Dr Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 09/25/2016
200HollostoneDr- 140926 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing, siding, windows and gutters.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
,_mt ._,. _. 91 MEMO
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, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
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Date
Signature of Applicant
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CITY Of t)LAIQ
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ROOF PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular code
requirements and /or roofing permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility to know the 2009 International Building
Code requirements that apply to your project. Please understand this document is only
designed and distributed to aid you in your roofing permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner /contractor for this project.
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, /�' Ownerbccupant Contractor
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City of Blair 0 Date
EDUALHOUSIND
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218 South 16th Street Blair, Nebraska 68008 e 402 - 426 -4191 e Fax 402 - 426 -4195 - E -mail cityofblalr @ci,blair.ne.us O