3196.tif 4
I
CITYOFBLAIR
j 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
.�.,� � ;� �, -'' ry � UIlC�ItI et"�'1'tit Application (402} 426 -4191 -Phone
, (402) 426 -4195 - FAX
vIS 2014- 03196
pro _ - www.blairnebraska.org
htlse of �
i
intern MfSC Residential November3, 2014
10/30/2014
LOCATIONOFIMPROVEMENT 2364 Lincoln St, Blair, NE 68008
ARCHITECT:
GENERAL McKinnis Roofing & Sheet Metal
OWNER: Thorkild And Tove L Pedersen CONTRACTOR
: 164S 1st St
2364 Lincoln St Blair, NE 68008
BLAIR, NE 68008 -0000
F-
r
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 11/02/2016
2364LincolnSt- 141030 -2014 Storm Damage ES TIMATED COMPLETION DATE 12131/2014
DESCRIPTION O F WORK
Roof, gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
i
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.
i
5. The undersigned owner or agent agrees to perform the proposed work in accordance with the specifications set forth above and j
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
appl'rca 'on.
Date
signature of App ant