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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
UIld111g Permit Application (402) 426.4191- one
(402) 426 -4195 - FAX
MS- 2014 -03078 � 01 a � °`� www.blairnobraska.org
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1 011 61201 4 intent MISC Commercial October 17, 2014
LGCATIONOFIMPROVEMENT: 1050 Grant St, Blair, NE 6800$
ARCHRECT:
F� GENMAL McKinnis Roofing & Sheet Metal
ONNER: Pat And Lanai Thompson CONTRACTOR:
164 S 1st St
1333 South St Blairp NE 68008
ry
BLAIR, NE 68008.0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 10/16/2016
1050GrantSt- 141016 -2014 Storm Damage 12131/2014
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Shingles, Slding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
- 1`1777�' 77777
✓. 'jj S ..
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 codeslordinances 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
application.
Signature t ppiicant Date
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