ms-2015-295_0001.tif CITYOF BLAIR
✓' 218 S. 16TH STREET
rr BLAIR, NEBRASKA 68008
ij Building Permit Application (402) 426 - 4191 - Phone
MS - 2015 - 00295 (402) 426 - 4195 - FAX
p '��ns e of a� www.blairnebraska.org
04/2312015 MISC Residential April 23, 2015
LOCATION OF IMPROVEMENT: 809 N 13th St, Blair, NE 68008
a ARCHITECT:
"yz GENERAL Thompson Roofing
{sa 3 OWNER: Eastern Nebraska Human Services Agency CONTRACTOR:
'I r 4436 S 12th St
900 S 74th Plz Ste 200 Omaha, NE 68107
OMAHA, NE 68114 -0000
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NATURE OF WORK STRUCTURE
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Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 04/2212017
809N13thSt- 150423 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
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DESCRIPTION OF WORK
Roof and Gutters
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: 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 intenti h of the undersigned or any alteration or change from this application without approval of the
Building Official, shall consti sufficient ground for the revocation of any permit issued which was based on the approval of this
ap plication.
Si ature of Date
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