MS-2015-00174_0001 (2).tif i
CITYOF BLAIR
218 S.16TH STREET j
BLAIR, NEBRASKA 68008 I
a Building Permit Application (402)426.4191 -Phone
MS -20'15 -00174 �a`��f (402) 426-4196 - FAX
rise of a www.blairnabraska.org
03/1912015 bpeterse MISC Commercial March 20, 2015
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LOCATIONOFIMPROVEMENT: 753 N 16th St, Blair, NE 68008 i
ARCHITECT:
GENERAL Jorgensen Contracting, Inc.
OWNER: T Thomas And Caryn E Anderson CONTRACTOR:
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530 Front St
753 N 16th St Blair, NE 68008
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Storm Repair Commercial Building
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PROJECT NAME PERMIT EXPIRES 03/19/2017
753N16thSt- 150319 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2015
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DESCRIPTION OF WORK
Replace metal roof.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS 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 I
this building permit. It is further understood that construction covered by this permit application shall not be commenced until a j
copy of a permit signed by the Building Inspector is issued. I
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
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I n Official, shall G i u su ient round for the revocation of any permit issued which was based on the approval of this i
applic n
ature of Applicant Date
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