ms-2015-350_0001.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2015 -00350 ° wise of ado www.blairnebraska.org
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05/05/2015 bpeterse MISC Residential May 5, 2015 77
.; LOCATIONORMPROVEMENT: 2447 Fontanelle Blvd, Blair, NE 68008
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ARCHITECT:
GENERAL Paul Davis Restoration of Omaha, Inc
, OWNER: Andrew H And Susan M Robak CONTRACTOR:
V 3505 S 61stAve Cir
i 2447 Fontanelle Blvd Omaha, NE 68106
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair
Primary Residence
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PROJECT NAME
PERMIT EXPIRES 05/04/2017
2447FontanelleBlvd- 150505 -2014 Storm 12/31/2015
Damage ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Siding, Roofing 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 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
application.
Sig re of Applicant Date
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