Signsture Pagere vou+�—
A $500.00 refundable deposit is being collected for any new commercial, new
residential, and any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
addition or accessory building valued under $10,000.
A $50.00 refu dable deposit is being collected for all misc. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period: —
1) Theft of water service by the plumber, owner or general contractor.
2 All permits have not been obtained.
3A required inspections have not been obtained.
Occupancy occurs prior to a final inspection.
5 e project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
I hereby agree to the above conditions, and understand that should any or
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
Contractor/Owner
Contractor/Owner
Al
Date City of Blair
CITY OF BLAIR �
Z0S16TH ST
'LAIR NE 68008
_____—______________ �
DeMptior, Amont
----------------- ____________
Permit # DR -21-320-00018
TIM ANDERSON CONSTRUCTION
CHECK M5Q1
^ PERMIT PAYMENT 275.0D
CHECK # 6501
CWK RKkmd
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FD
___________________FD 10/30/2O0902 RqtH 3703!