2726.tif C
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Bu ilding Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
MS -2014 -02726 11 Mis of ° www.blairnebraska.org
09/15/2014 MISC Residential September 15, 2014
LOCATION OF IMPROVEMENT: 1074 Washington St, Blair, NE 68008
ARCHITECT:
. GENERAL Jorgensen Contracting, Inc.
OWNER: Donald Dale Kruse CONTRACTOR:
530 Front St
1074 Washington St Blair, NE 68008
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 09/14/2016
1074WashingtonSt- 140915 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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 f the undersigned or any alteration or change from this application without approval of the
Bui.I ing Official, shall . constitute su cient ground for the revocation of any permit issued which was based on the approval of this
ap I'caf on j
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Signature of Applicait Date
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