MS-2014-00050.tif CITYOFBLAIR
218S.16TH STREET �
E
BLAIR, NEBRASKA68008 E
g Phone
(402) 426 -4191 -
Buildin IPermit Application
(402) 426 -4195 - FAX
MS-2015-00050
www.blairnebraska.org E
02/4/2015 1 8hellyJ MISC E Residential February 4, 2015
t g LOCATION OF IMPROVEMENT: 1706 Nebraska St, Blair, NE 6Q008 ARCHITECT -GENERAL C & S Roofing Inc.
OWNER: - Michael Alan Childs CONTRACTOR:
j 2211 Peoples Rd Ste B
1706 Nebraska St BELLEVUE, NE 68123
:.
BLAIR, NE 6$008 -0000
A
NATURE OF WORK STRUCTURE
Storm Repair ;Primary
PROJECT NAME PERMIT EXPIRES 02/03/2017
f
1706NebraskaSt- 150204 -2014 Storm Damage 12/31/2015
ESTIMATED COMPLETION DATE
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DESCRIPTION OF WORK
Reroof E
F
1
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
t
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 acknowlOdges 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 j
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. nstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signature of-- Applican
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