MS-2015-00162_0001 (2).tif i
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CITYOFBLAIR -
218 S.16TH STREET
BLAIR, NEBRASKA 68008
B uil d ing Per App lic a ti o n
(402)426.4191 -Phone I
a� (402) 4264195 - FAX
MS -2015 -00162 ae of Qv www.blairnebraska.org
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03/19/2015 bpeterse MISC Residential March 20, 2015
LOCATIONOFIMPROVEMENT: 1041 Jackson St, Blair, NE 68008
ARCHITECT:
GENERAL Jorgensen Contracting, Inc.
OWNER: Wayne R And Jane A Smith CONTRACTOR:
530 Front St
1041 Jackson St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Accessory Building
PROJECT NAME PERMIT EXPIRES 03/19/2017
1041JacksonSt- 150319 2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
DESCRIPTION OF WORK
Replace carport, attached garage metal roof.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck1COMcheck 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. j
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 i
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
ildi g Official, shalt constit ufficient ground for the revocation of any permit issued which was based on the approval of this
app .
ignature of Applica Date