3063.tif � y CITYQFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402 426-4191 � Phone
(402j ) 426 -4995 •FAX
VIS - 2014 - 03063 /se °I a �° www.blairnebraska.org
10/1512014
intern MISC Residential October 16, 2014
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LOCA110NOFIMPROVEMENT: 11632 Olive Branch Ln, Blair, NE 68008
ARCHITECT:
GENERAL McKinnis Roofing & Sheet Metal
OWNER: a Tilson CONTRACTOR
Marlen
.; 164 5 1st St
11632 Olive Branch Ln Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 10115/2016
116320live Br anchl.n- 141016.2014 Storm ESTIMATED COMPLETION DATE 12/31/2014
Damage
DESCRIPTION OF WORK
Roof, siding, gutters, windows, doors, fascia
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
O r ='.�'zy
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 j
app lic tion.
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Date
signature of Appl ant
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