BPM0112_ ~ MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
~ ~ ~ Permit Fee: $ ~
JOB ADDRESS I O ~ ~ ~ I ~~(h ,/~
rI \ r~
LEGAL
1 ~ DescR. LOT N0. BLK. TRACT
O SEE ATTACHED SHEET
2. OWNER ~ U i r ~C ~ MAIL ADDRESS ZIP ~r i j ~, (/ ~l PHONE
~
3• CONTRACTOR ~ ~~ n o ` MAII,.(1DDRESS ` ~~ ~e C ~ NE ~ / ` ~~
J
/
T
J LICENSE NO.
4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL
DDITIONS
O REMO
D
ELING/A REPLACEMENTS
5• Describe Work: ~Gu'~Y10/~rL - 7 5 ~ UU C~ lllY~ ~I
Comments:
~h f~Y~ ~r,~2Q- rc~- MECHANICAL PERMIT FEES
/~ ~
(J=-,Y~ ~ Forced Air Systems
Per Unit Commercial/Residential (New) .............. ~
............~:....... $25
00
.
,- ,P'"
~
~
~-
~ Air-Conditioner Unit /0`~
~~~~ ~
~, ~ 2, 2- Per Urnt Commercial/Residential (New) .............. ........................ $10.00
t ~0' ~ i
,`~ Refrigeration Urnts/Coolers
Per Unit Commercial (New or Replacement) ...... ........................ $10.00
NOTICE
I hereby certify that I have read and examined this
application and know the same to be true and correct. All Forced Air Systems/Air Conditioner
Unit Replacement
~~. U(~
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
Per Unit Commercial/Residential (Replacement)
........................ $10.00
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local
law regulating construction or the performance of
construction.
Permit Issuance Fee ............. $15.00
1 ~ -C~_
a
TOTAL
SIGNATURE OF CONTRA TOR OR AUTHORIZED AGENT
,A l-~ ~ ~' ~
Current License on File Yes O No
O NA 1~,~~
DATE
K M .
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS/~UR PERMIT
Comment: Approved By: /d /
POUNDS PRTG: Blair, NE /% ~ Rev. 12195
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