MS-2015-00040_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426.4191- Phone
(402) 426 -4195 - FAX
MS- 2015 -00040 /Se of Q www.blairnebraska.org
0112812015 bpeterse MISC Commercial January 28, 2015
LOCATIONOFIMPROVEMENT: 1654 Washington St, Blair, NE 68008
ARCHITECT:
GENERAL Mercury Contractors, Inc.
5, OWNER: Chandra M Petersen CONTRACTOR:
4222 Davenport
16 21641 Co Rd OMAHA, NE 68132
ARLINGTON, NE 68002 -0000
EM 500 z
E— 1 0m, N 0
NATURE OF WORK STRUCTURE
Storm Repair Choices Counseling Building
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PROJECT NAME PERMIT EXPIRES 01/2712017
1654WashingtonSt- 150128- 2014Storm
Damage ESTIMATED COMPLETION DATE 4/28/2015
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DESCRIPTION OF WORK
EPDM (Rubber membrane roofing)
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 agenj--qgrees to perform the proposed work in accordance with the specifications set forth above and
in accordance with the codes/df dinances 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, hall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
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application.''
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Date
Signature of Applicant