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MS-2014-03359.tif FEE- 07-2009 21:30 From: To:4024264195 P.1f1 i CI Y017 BLAIR 218 S. I GTH STREET BLAIR, NEBRASKA 68008 W (402) 426- 4191 - Phone lu ildin ermi Application (402) 426 - 4195 FAX MS - 2014- 0336 www.blairnebra ka.+ rtd i E 12/1�112Q14 bpeterse MISG Residential © eoe��nber 11, 2014 LOCATIONQFIMPRnvEMENT 554 S 13th $ t, Blair, NE 68000 a ARCHITECT: � GENERAL Classic Homes OMER: Terry R And Sandra L H ansen CO NTRACTOR R+tiI Brix 245 - 7457 Windhill Ln FT CALHOUN NE 58023 BLAIR, NE 68008 -0000 A 1 l NATURE OF WO STRUCTURE - [ Sign Primary Residence PERMIT" EXPIRES 12110120116 PROJECT NAME 664313thSt- 14"1211 -2014 Storin Damage ESTIMATE[ COMPLETION D AT E 12131/2414 DESCRIPTION OF WORK Ike -Roof DEPOSIT PAID BY: SIT FLAN SUBMITTED: NA Contractor RESchecklCOMcheck $UBMITTED: NA DEPOSIT STATUS: BUILDING PUNS SUBMITTED: NA $60 x I No work will he 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. i 4. The undersigned owner or agent understands and acknowledges this building permit application does not wnstitute 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 - key 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 Bla 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 suffici nd for the revocation of any permit issued which was based on the approval of this ate Signature of Applicant I