BPP0722PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 ~~~ ~
Application Date: ~ o~~ -
Permit Fee: $ i~
JOB ADDRESS
LEGAL
1 • DescR. LOT N0. BLK. TRACT
O SEE ATTACHED SHEET
,Z• OWNE ~/v/~ ~ MAILADDRESS ~ ~ ZIP PHONE
3• CONTRAC 0 ~ MAIL ADDRESS PHONE
~ 3 7~ ~
/~~ LICENSE N0.
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r .
4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELIN DDITION O REPLACEMENTS
5• Describe Work: "' `
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Comments:
PLUMBING PERMIT FEES
~ I ~~ `~~
Type of Fixture No. ((~
`
Kitchen .................................. $8.00 x ~(
Bath ....................................... $8.00 x
Rough-In Bath ....................... $4.00 x
Utility ..................................... $5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ........................ $10.00
NOTICE Sewer .................................... $10.00
I hereby certify that I have read and examined this Groundwork ........................... $10.00
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Septic Tank & Laterals .......... $10.00
work will be complied with whether specified herein or not.
The granting of a permit does not presume to give authority
Lawn Sprinkler System ..........
$10.00 ~
~8. ~ L7
to violate or cancel the provisions of any other state or local
Sprinkler System ................
..
$30
00
law regulating construction or the performance of .
(Commercial) .
construction.
Permit Issuance Fee $15.00 `~~~~
SIGNATUR CONTRACTOR AUTHORIZED AGENT
T
l' D
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`~ ~ ~ OTAL ~
DATE Current License on File OYes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro d
POUNDS PRTG: Bleu, NE Rev. 12195
.e BUILDING INSPECTION'REPORT'
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^ CTI'Y OF BI:AIR ^ WASHINGTON COUNTY ^ OTHER
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'~~~ ~
~f ~
LOCATION•OF INSPECTION; ~
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NAME OF OWNER-°°.-~°~ '~ CONTRACTOR:
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DATE INSPECTION REQUESTED: t '°
PERMIT NO:
TIME INSPECTION REQUESTED: ~ ~~
~~~~-.~
TYPE OF INSPECTION REQUESTED:. ~ , ~ ~ ~~
BUILDING:.. •
FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
• .
.UTILITIES: •
' ^ SEWER' TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ PTXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
ROUGH-IN ^ A/C ^ FINAL.
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL '
RESULTS OF THE INSPECTION: • ~ASSED (s~rroTESj . ^FAILED (s~xoTFS)
i
NOTES/REMARK$;
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INSPEC
.
I
M
E
' ~~ _ ..
TIME
AD
ON
:
DATE.OF WSPECT :
_
• `''-t~ED OPPD\ ~ PTO CONNECT SERVICE:. .^ YES . ^ N0 '
'.' .. `"'~ CALL OPPp\ ^ X~ ^ NO,` BLR 1
•