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CITYOF BLAIR c --
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
IIC�It1C� C I pplic 11011 (402) 426 -4191 - Phone
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(402) 426 -4195 - FAX
MS -2014 -03318 /Se o Qu www.blairnebraska.org
12/03/2014 ::J bpeterse MISC Residential December 3, 2014
LOCATIONOFIMPROVEMENT: 8629 Victory Ln, Blair, NE 68008
ARCHITECT:
GENERAL Denny's Roofing
�� OWNER: Terry And Patricia Burmeister CONTRACTOR:
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2400 Hollow Rd
r 8629 Victory Ln Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 12/02/2016
8629VictoryLn- 141203 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Roofing, Siding and Gutters.
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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
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.
12 sf/
Ile Date
Signature of Kpplicant
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