MS-2015-00306.tif i
CITYOF BLAIR I
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
MS -2015 -00306 ° rIse of aJO\\ www.blairnebraska.org
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04/27/2015 ShellyJ MISC Residential April 27, 2015 7
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A LOCATION OF IMPROVEMENT: 2347 Washington St, Blair, NE 68008
ARCHITECT:
p� GENERAL Ted Dohmen Roofing Inc
} OWNER: Charlotte Joy, Etal Christopher CONTRACTOR:
P.O. Box 4661
2550 Bald Mountain Rd OMAHA, NE 68104
VAIL, CO 81657 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 04/26/2017
2347WashingtonSt-1 50427-2014 Storm ESTIMATED COMPLETION DATE 12131/2015
Damage
DESCRIPTION OF WORK
Reroof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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, ventilating and air conditioning, septic system.
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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 O icial, s nstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
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Date
Sig ture of pplicant
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