3258.tif 1
CITYOF BLAIR I
218 S. 16TH STREET j
BLAIR, NEBRASKA 68008 4
B uilding P A pp licati o n
(402) 426 -4191 - Phone
S -2014 -03258 .ono . (402) 426 -4195 -FAX
rise of a www .blairnebraska.org
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11/06/2014 bpeterse MISC Residential November6, 2014
a LOCATION OF IMPROVEMENT: 842 N 12th St, Blair, NE 68008
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ARCHITECT:
GENERAL Eric Adams Contracting LLC I
a WINER: Tina L And James Bilslend CONTRACTOR:
1911 Avenue C
842 N 12th St COUNCIL BLUFFS, IA 51501
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 11105/2016
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842N12thSt- 141106 -2014 Storm Damage �
ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Re -Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
a a s a a
ON
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 i the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or w h ut the intention of the undersigned or any alteration or change from this application without approval of the
Building Offi i I, shall consti ute sufficient round for the revocation of any permit issued which was based on the approval of this
application.
/J�
Signature of Applicant
Date
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