Building Permit (4).tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
. Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
SA- 2015 -00 jse at qJ� www.blairnebraska.org
02/24/2015 ShellyJ SIGN -AWN Residential March 10, 2015
LOCATIONOFIMPROVEMENT: 1115 Washington St, Blair, NE 68008
ARCHITECT:
® GENERAL The Sign Depot
OWNER: Sandra K Co- Trustee Carmichael CONTRACTOR:
760 Front St
549 S 23rd St Blair, NE 68008
BLAIR, NE 68008 -0000
omm..Y
Y
NATURE OF WORK STRUCTURE
Carquest Auto Parts
Sign
PROJECT NAME PERMIT EXPIRES 03/0912017
1115WashingtonSt- 150224 -Sign ESTIMATED COMPLETION DATE 5/2412015
i
i
DESCRIPTION OF WORK
New Carquest Auto Parts Sign
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COM check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
$50
r
q
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
id' g Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
pplic 'off
Date
4atf Applicant
Si 1� o
I
i
i
r -
' of
promise
o�
BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected for any new commercial, new
residential, and any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
.aad& or access. ory building valued under $10,000.
A $50.00 r fundable deposit is being collected for all misc. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) Theft of water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (if Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
I hereby agree to the above conditions, and understand that should any or .
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
i
1
Contractor /Owner Contractor /Owner
City of Blair
I
Date
i
i
i