MS-2015-00844.tif CITYOFBLAtit
r� 218 S.16TH STREET
; BLAIR,NEBRASKA 68008
Building Permit Application (402)426-4191 Phone
(402}426-4195-FAX
- O'(S�OD$ 4 °rpn,rs9 of�'° www.blairnebraska.org
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10105/2015 MISC Residential October 5,2015
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,4< LOCATIONORMPROVEMENT: 1-123 N 1761 Ave,Mair, NE 68008
e/x ARCHITECT;
GENERAL Jim La HoodConstruction, Inc.
f is OWNERrlstopher It Ahrens CONTRACTOR
802 S. 50th Ave
1123 N 17th Ave
Omaha,NE 68106
BLAIR,ISE 68008-0000
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NATURE OF WORKSTRUCTURE
Storm Repair Primary Residence
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PERMIT EXPIRES 10/0412017
PROJECT NAME
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1123N17thAve-151005-2014 Storm Damage ESTIMATED LETI DATE 12/31/2015
DESCRIPTION F WORK
Roof Asphalt with vinyl gutters.
DEPOSIT PAID BY: SITE PLAN SUBMITTED, NA
Contractor
RE acheck/OO check 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
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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 codeslordinances of the City of Blair and the StateofNebraska. 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 fficient ground for the revocation of any permit issued which was based on the approval of this
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Date
Sign re cf Applicant
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