MS-2015-00128.tif i
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
uilding Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 -FAX
MS- 2015 -00128 /Se of a ° www.blairnebraska.org
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0311112015 bpeterse MISC Residential M 2015
LOCATIONOFIMPROVEMENT: 564 S 17th St, Blair, NE 68008
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GENERAL O'Dell Enterprises
OW CONTRACTOR:
OWNER: Ronald R And Gloria Jensen i
� 4558 Pioneer Rd
564 S 17th St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK
STRUCTURE
Storm Repair Primary Residence
PERMIT EXPIRES 03/10/2017
PROJECT NAME
564S17thSt- 150311 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
DESCRIPTION OF WORK
Siding and a window.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: 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
Buildin era/; tshall- constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
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Date
Signa ure of Appil cant