ms-2015-353_0001.tif C
CITY0FBLAIR C
�r 218 S.16TH STREET
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BLAIR, NEBRASKA 68008
Building Permit Application (402) 426- 4191 - Phone {
(402) 426 -4195 - FAX
MS «2015600353 A ' °M�Se CA �+' www.blairnebraska.org
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05/0712015 MISC Residential May 7, 2015
LOCATIONOFIMPROVEMENT: 873 N 15th St, Blair, NE 68008
�Ti 1 ARCHITECT:
Ipf GENERAL MJ Builders
OVER Leanna E Metz CONTRACTOR:
87697 580th Ave
873 N 15th St Dixon, NE 68732
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 05/06/2017
873Nrl5thSt- 150507 -Storm Damage 12/31/2015
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roofing, siding and gutters.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck1COMcheck 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 Officit shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signature of Ap{f icant
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