PL-2015-00918_0001.tif i
CITYOF BLAIR
218 S.16TH STREET
BLAIR,NEBRASKA 68008
MINOR- Building It pp1cation (402)426-4191 - Phone
(402)426-4195-FAX
PL-2015-00918 ise of aurwww.blairnebraska.org
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11/03/2015 lbrwheele PLUMBING Residential November3,2015
"t LOCATIONOFIMPROVEMENT: 1068 Park St, Blair, NE 68008
ARCHITECT:
GENERAL Dan's Handyman
OWNER: Dean W And Rita S Stacy CONTRACTOR:
- 1120 N 28th Ave
4A 97 3rd Ave Blair, NE 68008
MALVERN,IA 51551-0000
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NATURE OF WORK STRUCTURE
Elect/Mech/Plumbing
Primary Structure
PROJECT NAME PERMIT EXPIRES 11/02/2017
1068ParkSt-151103-Plumbing
ESTIMATED COMPLETION DATE 12/1/2015
DESCRIPTION OF WORK
Replacing water line
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
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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.
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Signature of Applicant Date