MS-2015-00107_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Build Permit App lica tion (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
Is of a ° www.blairnabraska.org
03/0312015 MISC Commercial March 3, 2015
LOGATIONOFIMPROVEMENT: 1765 Washington St, Blair, NE 68008
ARC GENERAL McKinnis Roofing & Sheet Metal
OWNER Larry J And Donna K Pavel CONTRACTOR:
164 S 1st St j
5621 N 167th St Blair, NE 68008
OMAHA, NE 68116 -0000
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NATURE OF WORK STRUCTURE
Roofiing/SofrdJEaves /Gutters Pavel
PRO JECT NAM PERMIT E XP IRES 0 310212 0 1 7
1765Was hingtonSt- 150303 -2014 Storm
Damage ES TIMATED COMPLE DA 12/31/2015
DESCRIPTION F WORK
Replace 60 rail EPOM Roof System. Gutter /Downspouts
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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.
5ignatur f Applicant Date