MS-2015-00068_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA68008
Bu i ld ing I Appl ication (402) 426 -4191 -Phone
(402) 426-4195. FAX
MS -201 5 -00068 p ` °� : art a� °� www. blairnebrask a.org
)211212015 _ MISC _ Commercial February 12, 2015
LOCATIONOFIMPROVEMENT: 1454 Colfax St, Blair, NE 68000 j
ARCHITECT:
GENERAL McKinnis Roofing & Sheet Metal
I� OWNER Benjamin W Hansen CONTRACTOR
164 S 1st St
540 S 17th St Blair, NE 68008
BLAIR, NE 68008.0000
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NATURE OF WORK STRUCTURE
Storm Repair Hansen Chiropractic
PROJECT NAME PERMIT EX 02/11/2017
1454ColfaxSt- 150212 -2014 Storm Damage
ES TIMATED ETI N DATE 5!1212015
DE OF WORK
Remove and replace EPDM roof on office and remove and replace shingle roof on garage, siding and gutters /down
spouts.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
EScheck/COMcheck SUBMITTED: NA
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DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
.
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.
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49natur Applicant t Date
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