ms-2015-266_0001.tif i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
a, (402) 426 -4195 - FAX
MS- 2015 -00266 ° wise of Quo www.blairnebraska.org
04/17/2015 r
Residential April 17, 2015 7
1 LOCATIONOFIMPROVEMENT: 9515 Pine Crest Rd, Blair, NE 68008
ARCHITECT:
GENERAL Monarch Siding & Windows Inc.
OWNER: Patrick C And Ann L Nichols CONTRACTOR:
308 E Cary St '
d s' 9791 Squirrel Run PAPILLION, NE 68046
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 04/1612017
9515 Pine CrestRd- 150417 -2014 Storm 4/17/2015
Damage ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roof
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: 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, 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 wt or without the intention of the undersigned or any alteration or change from this application without approval of the
Buildi Offi'c al, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap li tion.
G (7 F y
Date
Signature of Applicant