MS-2015-00535_0001.tif i
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CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
y �: �• (402) 426 -4195 - FAX
MS- 2015 -00535 °'17l Of Q www.blairnebraska.org
06/29/2015 MISC Residential June 29, 2015
LOCATIONOFIMPROVEMENT:
� 795 N 3rd St, Blair, NE 68008
ARCHITECT: GENERAL F/S Contracting
OWNER: Timothy D And Ann Marie Miller CONTRACTOR:
324 S 13th St
u� 795 N 3rd St Tekamah, NE 68061
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Roofing /Soffit/Eaves /Gutters Primary Structure
PROJECT NAME PERMIT EXPIRES 06/2812017
795N3rdSt- 150629 -2014 Storm Damage ESTIMATED COMPLETION DATE 1213112015
DESCRIPTION OF WORK
Reroofing, siding and gutters
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 j
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
application.
Date
Signature of Applicant
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