MS-2015-00177_0001.tif CITYOFBLAIR
218 S.16TH STREET
BLAIR, NEBRASKA 68008
Building ermit Application (402) 426 - 4191 - Phone
A 'o . oo��•a (402) 426.4195 - FAX
MS - 2 01 5-00177
"+:e oc a www.blairnebraska.org
03/19/2015 bpeterse MISC Residential March 20, 2015
LOCATIONOFIMPROVEMENT: 1233 Jackson St, Blair, NE 68008
� - ARCHITECT: � I I
GENERAL Jorgensen Contracting, Inc. j
OMER Kori L And Randall P, Trustees Hodgson CONTRACTOR:
530 Front St 1
1233 Jackson St Blair, NE 68008
BLAIR NE 68008.0000
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NATURE OF WORK STRUCTURE
Storm Repair Accessory Building
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PROJECT NAME PERMIT EXPIRES 03/19/2017
1233JacksonSt- 150319 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
DESCRIPTION OF WORK
Replace roof, west and north wall metal, cupola and gutters.
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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. i
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 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 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 I
in Official, shall 'tute I ent ground for the revocation of any permit issued which was based on the approval of this
appli o�
i ature of Applican Date
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