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04- 24 -'15 15,06 FROM- Absolute Customs T -327 P0001/0001 F -514
CiTYOFBLAIR
218 S. 76TH R7>�1 =ET j
BLAIR, NEBRASKA 68008
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B er It App li cation (402) 426 -4191 - Ph
y , � (402) 426 -4105 - FAX
MS -2015-00276 °misQ flt ��` www.blairnabraska,org
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0412012015 MISC Residential April 20, 2015
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LOCATIONOFIMPROVEMENT: 851 N 11th St, Blair, NE 68008
r ARCH Et�T" GENERAL Absolute Roofing
r OWNER: Lynette S Hansen CONTRACT
17934 W Center Rd Ste 110 -145
851 N 11th St OMAHA, NE 68130
BL.AIR, NE 68008 -1335
A 11111111
NATURE O F W ORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME
PERMIT EXPIRES 0411912017
851 N11 thSt- 150420 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112015
DESCRIPTION OF WORD
Roofing
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RE=Scheck/COMcheekSUBMITTED. NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
e s
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 Nefraska. 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 Offi ' I, shall constitute su cient ground for the revocation of any permit issued which was based on the approval of this
application.
; 44-044�-�
s(gnat App leant
Date