MS-2014-03335_0001.tif CITY OF BLAIR I
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS 2014 -03335 Al ��fs0 01 www.blairnebraska.org
12/0912014 intern MISC Residential December 11, 2014
LOCATIONOFIMPROVEMENT: 821 N 14th St, Blair, NE 68008
ARCHITECT:
GENERAL Jorgensen Contracting, Inc.
s OWNER: Ernest And Carolyn A Brenneis CONTRACTOR:
530 Front St
821 N 14th St Blair, NE 68008
BLAIR, NE 68008 -0000
M- 0, E— i
SEE= = gyA
NATURE OF WORK STRUCTURE
Storm Repair Accessory
PROJECT NAME
PERMIT EXPIRES 12/10/2016
821N14thSt- 141209 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/3112014
DESCRIPTION OF WORK
Roof, metal walls on Out Building
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.
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 "th or without the intent* of the undersigned or any alteration or change from this application without approval of the
Suildin Official, shall constitute ci nt ground for the revocation of any permit issued which was based on the approval of this
applic ti
i nature of Applicant Date
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