MS-2015-00209_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
. (402) 426 -4191 - Phone
B uilding Permit Appl ication j
(402) 426.4195 - FAX
MS- 2015 -00209 °m,Se °f www.blairnebraska.org
0313112015 MISC Residential March 31, 2015
LOCATIONOFIMPROVEMENT: 10669 Oak Park Ln, Blair, NE 68008 j
ARCHITECT:
a GENERAL South 0 Roofing
OWNER: Susan L Ryan CONTRACTOR:
4060 Vinton #106
10669 Oak Park Ln Omaha, NE 68105
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME
PERMIT EXPIRES 03130/2017
106690ak ParkLn- 150331 -2014 Storm 12!31(2015
Damage ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Roof and siding replacement.
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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 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
Building �C)f+ ial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appiea ion
3 -3,�
Signature of Applicant Date