3215.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
(402) 426 -4191 - Phone j
B uilding Pe Application
(402) 426 -4195 - FAX j
MS- 2014 -03215 se �� www.blairnebraska.org I
10/3112014 M Residential October 31, 2014
LOCATIONOFIMPROVEMENT: 865 N 10th Ave, Blair, NE 68008
ARCHITECT:
AF GENERAL FIS Contracting
� OWNER: Dane B And Katie R Petersen CONTRACTOR:
324 S 13th St
865 N 10th Ave Tekamah, NE 68061
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Structure
PROJECT NAME PERMIT EXPIRES 10130/2016
865N10thAve- 141031 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Reroof, siding, windows
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RES check/CO Mcheck 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 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 j
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
applica ' //
Date
S of Applicant
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