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Rict C 200 South Silber North Platte NE 69101-4200 OFC (308) 535-8181 FAX (308) 535-8259 http://www.sfm.ne.gov Date SUBMITTING PARTY NAME OF PROJECT ADDRESS(MAILING ADDRESS) ADDRESS (STREET ADDRESS) (CITY, STATE, ZIP CODE) (CITY, STATE, ZIP CODE) CONTACT PERSON PHONE EMAIL ADDRESS (If code review via email is desired) NUMBER SUBMITTED GENERAL PROJECT INFORMATION TYPE OF OCCUPANCY STATE-OWNED BID DATE ESTIMATED START DATE TYPE OF PLAN YES NO ESTIMATED COMPLETION DATE Fina.

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