2971.tif Oct, 6. 2014 2: 16PM No. 0636 P. 1
Cl
218 8.16TH STREET
13LAIP.,NEBRASKAG8008
(402)
Building Permit Application ( 4o2} 420-4191 - Phone 402) 426-4199 -FAX
MS-2014-02971 V,6! amise : V www.blairnabraska.org
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10106=12014 intern misc Residential October 6, 2 014
LOCATIONOFIMPROV2M2NT' 1818 Grant St, Blair, NE 68008
ARCHITECT: GENERAL Pyramid Roofing
OWNER: Robert A, Etal Olson CONTRACTOR:
1504 S SaddIscrask Rd
12896 Co Rd P20 Omahap NE 68106
BLAIRp NE 68008-0000
SELECTED CHARACTERISTICS OF WORK
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 1010512016
18180rantSt-1410062014 Storm Damage ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY SITE PLAN SUBMITTED: NA
Contractor
RESChsek[COMchock SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
AFFADAVIT OF APPLICANT
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 ' n of the undersigned or any alteration or change from this application without approval of the
Building Official, shall onstitut sufficient ground for the revocation of any permit issued which was based on the awroval of this
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pp Ica t 10 rt- q
Date
Signature of Applicant