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218 S, 16TH STREET
LA
IR, NEBRASKA 68008
Building Permit pplica i (402) 4264191- Phone �
(402) 4264195 - FAX
® 01 0 9 l of a�o�`�� www.blairnebraska.org
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14
Residential October 1, 20
NINE
09/30/201 intern MISC I
r , LOCATIONOFIMPROVEMENT: 1136 Rambleridg Dr, Blair, NE 6800
: ARCHITECT: GENERAL. E xterior R emodel and D esig n
OWNER: Jason C Shryock CONTRACTOR
f 14225 Dayton Cir
11361 Rambleridge Dr OMAHA, NE 6837
BL.AIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
S torm Re P rimary Resi
PERM 09/30/201
PROJECT NAME
11361 amleride r- 140930 -2014 Storm COMPLET 12131/2014
D ama ge
DESCRIPTION OF WORK
R oo f , gutters, siding, windows
DEPOS PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RES check/COMcheck SUBMITTED: NA
DEPOS STATUS: BUILDING U I 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 with or without the intention of the undersigned or any alteration or change from this application without approval of the
Building Offi ial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicatio
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a gnature pplicant