MS-2015-00821_0001.tif i
CITYOF BLAIR
218 S.16TH STREET
BLAIR,NEBRASKA 68008
Building 0• It Application (402)426-4191 - Phone
(402)426-4195-FAX
M$-2015-00821 °�+/Se of Q°° www.blairnebraska.org
Will
09/25/2015 bpeterse MISC Residential September 25,2015
LOCATION OF IMPROVEMENT: 529 N 16th St, Blair, NE 68008
ARCHITECT:
� GENERAL SELF
OWNER: Thomas L Gilliland CONTRACTOR:
529 N 16th St Blair, NE 68008
BLAIR,NE 68008-0000
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NATURE OF WORK STRUCTURE
Storm Repair Prmary Residence
PROJECT NAME PERMIT EXPIRES 09/24/2017
529N1 6thSt-1 50925-2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
DESCRIPTION OF WORK
Re siding house with vinyl.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Gilliland-Homeowner
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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 j
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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