MS-2015-00806_0001.tif 5, CITYOF BLAIR
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_ 218 S.16TH STREET
BLAIR,NEBRASKA 68008
wilding Permit Application (402)426-4191 - Phone
MS-2015�0�8�6 'om o (402)426-4195-FAX
rse of a www.blairnebraska.org
MENEM
09/21/2015 ShellyJ MISC Residential September 21,2015
` LOCATIONOFIMPROVEMENT: 2166 Washington St, Blair, NE 68008
ARCHITECTS
GENERAL SELF
OWNER: Juliann/Dixo Plugge , CONTRACTOR:
2009 C � L �+ Blair, NE 68008
BLAIR0000
5 .2`a'r.'>_
NATURE OF WORK STRUCTURE
Misc. Permit Primary Structure
PROJECT NAME PERMIT EXPIRES 09/20/2017
2166WashingtonSt-150921-Window
ESTIMATED COMPLETION DATE 11/3/2015
DESCRIPTION OF WORK
Install a block glass window in bathroom 24 1/4 x 32 1/4
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Self
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
$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
213pi dation.
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Signature Ap 4i ant Date