MS-2015-00285.tif i
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Bu ild ing P (402) 426 -4191 - Phone
_ (402) 426 -4195 - FAX
MS- 2015 -00285 lse of a� www.blairnebraska.org j
IN
111 N
F
0412212015 MISC Residential April 22, 2015
LOCATIONOFIMPROVEMENT: 11848 Cord P27, Blair, NE 68008
1 ' ARCHITECT:
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GENERAL Quinn Siders
OWNER: James A And Barbara J Blazina CONTRACTOR:
3314 Decatur St
11848 Co Rd P27 OMAHA, NE 68111
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 04/2112017
11848Cord P27- 150422 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2015
DESCRIPTION OF WORK
Reroof and siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
I. 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 Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
/
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Signature of Applicant