MS-2015-0161_0001.tif CITYOF BLAIR '
218 S. 16TH STREET !
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
9 ,aF (402) 426 -4195 - FAX
MS- 2015 - 0096'1 °m/ of a° www.blairnabraska.org
03/19/2015 bpeterse MISC Residential March 20, 2015
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LOCATIONOFIMPROVEMENT: 13621 State Hwy 91, Blair, NE 68008
} ARCHITECT. GENERAL Jorgensen Contracting, Inc.
OWNER: Jeffrey L And Carolyn M Young CONTRACTOR:
530 Front St
91 13621 State Hwy Blair, NE 68008
BLAIR, NE 68008 -5680
NATURE OF WORK STRUCTURE
Storm Repair Accessory Building {
PROJECT NAME
PERMIT EXPIRES 0311912017
State Hwy 91- 150319 -2014 Storm
Damage ESTIMATED COMPLETION DATE 12/31/2015
Damage
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DESCRIPTION OF WORK
Replace metal roof, west and north walls, gutters north overhead door, cupola.
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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 codeslordinances 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
ul ing — fficial, s stitu ufficient ground for the revocation of any permit issued which was based on the approval of this
app I
Si ature of Appli a Date i
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