Application - New MS-2014-02612.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
®. w Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2014 -02612 �MIse 01 qo www.blairnebraska.org
09/05/2014 bpeterse MISC Residential June 2, 2015
LOCATIONOFIMPROVEMENT: 2004 Colfax St, Blair, NE 68008
ARCHITECT: GENERAL SELF
OWNER: Greg And Susan Polsley CONTRACTOR:
32 6996 Co Rd Blair, NE 68008
FT CALHOUN, NE 68023 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residential
PROJECT NAME PERMIT EXPIRES 11/2912015
2004ColfaxSt- 140905 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
siding the North & West sides due to storm damage
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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 intention of the undersigned or any alteration or change from this application without approval of the
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Signature of Applicant Date