MS-2014-03079.tif f
CITYOFBLAIR
218 S. '16TH STREET '
BLAIR, NEBRASKA 68008
. .
Bull in P e rm i t Appl (402) 426-4191 -Phone
MS ° 2 01 °03079 9�r (402) 426 -4'195 - FAX
►as ct Q °° www.blairnebraska.org
10116/014 intern MISC Commercial October 20, 2014
LOCATIONOFIMPROVEMENT: 718 N 21st St, Blair, NE 68008
=.
� ARCHITECT:
R GENERAL McKinnis Roofing & Sheet Metal
r DER: Memorial Community Hospital CONTRACTOR:
164 S 1st St
Blair, NE 68008
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 10!1612016
718N21 stSt-1 41016-2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Roof, siding, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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1. No work will be started before a permit is ISSUED AND POSTED.
2. For commercial permits, a sat 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
application.
OV { _ 1012 -v1 z 01 1--f _
Signatur f Applicant Date