MS-2015-00415.tif i
CITYOF BLAIR 1
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
" a Bu ilding I I (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS-20 15-00415 a � ° wise of aU� www.blairnebraska.org
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05/21/2015 bpeterse MISC Residential May 21, 2015
x LOCATION OF IMPROVEMENT: 13621 State Hwy 91, Blair, NE 68008
ARCHITECT: GENERAL SELF
x OWNER: Jeffrey L And Carolyn M Young CONTRACTOR:
91 13621 State Hwy Blair, NE 68008
BLAIR, NE 68008 -5680
IN
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NATURE OF WORK STRUCTUR
Storm Repair Primary
PRO N
PERM I 05/20/2017
13621 State Hwy 91- 150521 -2014 Storm
Damage ES TIM ATED COMPLE DA T 12/31/2015
DESCR IPTION F K
Residing whole house
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
x x x x �
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 intention of the undersigned or any alteration or change from this application without approval of the
Building Official, shall c nstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applic
Signature -of Ap licant Date