MS-2015-00084_0001 (2).tif I
- -' CITY OF BLAIR
f J 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
!� liC tl (402) 426 -4991 - Phone
- � 5 - �1 � A'o` � (402) 426 -4195 - FAX
+3s <A .blairnebraska.org
02/24/2015 MISC Residential February 24, 2015
LOCATIONOFIMPROVEMENT: 11151 Co Rd P29, Blair, NE 68008
ARCHITECT.
GENERAL Jorgensen Contracting, Inc.
OWNER: Ann M, Quick, Randall D Wolsmann CONTRACTOR:
580 Front St
11127 Co Rd P29 Blair, NE 68008
B'LAIR, NE 68008 -0000
i
i
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 02/23/2017
11151 Co Rd P29 - 150224 -2014 Storm Damage ESTIMATED COMPLETION DATE 5/24/2015
i
DESCRIPTION OF WORK
Replace northwest galls and roof of pole building - Metal and trim.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLATS 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 9pplication without approval of the
uildin Offi ial, shall co e suffice nt d for the revocation of any permit issued which was based on the approval of this
applic n.
SI ature of Applicant Date
I
I
i