MS-2015-00645_0001.tif i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
MS- 2015 -00645 9p�� „o ° (402) 426 -4196 - FAx
m�Sg of a www.blairnebraska.org
08/0612015 ShellyJ MISC Residential August 6, 2015
'• LOCATIONOFIMPROVEMENT: 1840 Sunrise Dr, Blair, NE 68008
r . ARCHITECT:
r GENERAL MJ Builders
,. OWNER: David P And Nancy E Nielsen CONTRACTOR:
87697 580th Ave
8953 John Deere Ln Dixon, NE 68732
BLAIR,NE 68008 -0000
END
IBM
NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
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PROJECT NAME PERMIT EXPIRES 08/0512017
1840SunriseDr- 150806 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/3112015
DESCRIPTION OF WORK
Re -roof.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
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Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
1. No work will be started before a ermit is ISSUED AND ND 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
application.
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Signature of Applicant Date
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