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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
BUIlC�IIIg P @1"11111 Application
(402) 426 -4191 - Phone
a ��a (402) 426 -4195 - FAX
MS- 2014 -02999 °'n/s of www.blairnebraska.org
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10/08/2014 intern MISC Residential 7October 8, 2014
r LOCATIONOFIMPROVEMENT: 2052 Park St, Blair, NE 68008
ARCHITECT:
GENERAL Royalty Roofing
O WNER: Gerald L And Kathleen A Johnson CONTRACTOR:
3519 N 53rd St
2052 Park St OMAHA, NE 68104
BLAIR, NE 68008 -1540
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 10/07/2016
2052ParkSt- 141008 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roof, West and North siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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 with or without the intention of the undersigned or any alteration or change from this application without approval of the
Build in Official s constitute s cient ground for the revocation of any permit issued which was based on the approval of this
app M ��
Signature of Applicant Date
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