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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
ermit Application (402) 426 -4191 -Phone
Building
�, (402) 426 -4195 -FAX
MS -2015 -00255 ° �hise of www.blairnebraska.org
MISC Residential April 15, 2015
04/15/2015
LOCATION OFIMPROVEMENT: 11256 Co 27 Rd, Blair, NE 68008
ARCHITECT: GENERAL Nebraska Roofing and Drywall
CONTRACTOR:
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OWNER: Greg &Janet Nieto 6812 Sunshine Dr
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11456 Co 27 Rd OMAHA, NE 68107
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. Blair, NE 68008
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PERMIT EXPIRES 04/14/2017
PROJECT NAME
11 256C 27Rd- 150415 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
DESCRIPTION OF WORK
Re -roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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
B Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
lication.
Date
Signature of Applicant