MS-2015-00512_0001.tif i
I
CITYOF BLAIR j
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
it i (402) 426 -4191 - Phone
x (402) 426 -4196 - FAX
www.blairnabraska.org
06/1812fl1 a DISC Commercial June 18, 2015
LOCAMONOFIMPROVEMENT: 10748 Cord 29, Blair, NE 68008
ARCHRECT,
GENERAL Jorgensen Contracting, Inc.
OMER: Richard R And Laura U Co Roaring CONTRACTOR:
530 Front St
2910746 Co Rd Blair, NE 68008 {
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Role Barry
PRO JE C T NAME PERMIT EXPIRES 0611712017
i
10748Cord 29-150618 -2014 Storm Damage ESTIMA L TIDATE 12/3112015
D ESCRIPTION E WORK
Replace Roof, East and North Walls, Gutters, Cupola, Trim, Etc of Pole Building - Metal.
DEPOSIT PAID BAP: SITE PLAN SUBMITTED: NA
Contractor
REScheck/CO check SUBMITTED: NA
DEPOSIT STATUS:
$50 BUILDING FLANS SUBMITTED: NA
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 withou e intention of the undersigned or any alteration or change from this application without approval of the
i di Offi pshall ute suf ficient ground for the revocation of any permit issued which was based on the approval of this
' app i /� gnature of A Dat
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