MS-2015-00305.tif k
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
II Ill I Application (402) 426 -4191 - Phone
� ��;' (402) 426 -4195 -FAX
S -2015 -00305 A � ° fiise of ag www.blairnebraska.org
04/27/2015 ShellyJ MISC Residential April 27, 2015
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r LOCATION OF IMPROVEMENT: 2129 Park St, Blair, NE 68008
ARCHITECT: GENERAL
Ted Dohmen Roofing Inc
.......... OWNER: Jacob J And Chelsea A Loftis CONTRACTOR:
P.O. Box 4661
2129 Park St OMAHA, NE 68104
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
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PROJECT NAME PERMIT EXPIRES 04/26/2017
2129ParkSt- 150427 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2015
DESCRIPTION OF WORK
Reroof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck 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 'ntention of the undersigned or any alteration or change from this application without approval of the
Building fficial, a c stitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appli ion.
Signature of Applicant Date
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