ms-2015-298_0001.tif i
CITY OF BLAIR
218 S.16TH STREET
°a BLAIR, NEBRASKA 68008
(402) 426 -4191 - Phone
� Building Permit Application
pax?1 3t� °)� (402) 426 -4195 -FAX
MS - 2015 -00298 b '�ns e o� a ° www.blairnebraska.org
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b MISC Residential April 23, 2015
04/23/2015 p �
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✓✓ LOCATIONOFIMPROVEMENT: 1506 Park St, Blair, NE 68008
ARCHITECT:
GENERAL Donald Andersen &Family
CONTRACTOR:
owNER: Carol J Heinssen 235 S 9th St
Blair, NE 68008
1506 Park St
x BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE Primary Residence
Storm Repair
PERMIT EXPIRES 04/22/2017
PROJECT NAME
1506ParkSt- 150423 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2017
DESCRIPTION OF WORK
Roofing & Gutters.
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
pplicatjon. b_ l
I1 v Date /
Signature of Applicant