413 Application.tif i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
v l�I� Ong Perm p01 (402) 426 -4191 - Phone
q� �- (402) 426 -4195 - FAX
MS- 2015 -00771 ;s of a www.blairnebraska.org
0910912015 ShellyJ MISC Residential September 9, 2015
A LOCATION OF IMPROVEMENT: 413 S 25th St, Blair, NE 68008
y ARCHITECT:
GENERAL Black Bison Contracting
OWNER: Philip C And Karen F Green CONTRACTOR:
w 1948 Washington St
413 S 25th St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NA
MIT EX PIRES 09108/2017
413S25thSt- 150909 -2014 Storm Damage
ESTIMATED CO DATE 12131/2015
DESCRIPTION OF WORK
Reroof, gutters, north and south side gable
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RESchecliMcheck SUBMITTED: 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
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.
Sioiaturrr Applicant Date
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