BPP0807PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: / / ~ Permit Fee: $
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JOB ADDRESS ~ ~ /J --
LEGAL
1 • DESCR. LOT N0. BLK. TRACT
O SEE ATTACHED SHEET
2. 0 NER MAIL ADDRESS ZIP PHONE
3• C R / MAIL AD ESS ~ ~ ~ PHO LIC~fNSE~Q _ _)
4. Class of rk: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS EPLACEMENTS
5• Describe Work: [~Q
Comments:
PLUMBING PERMIT FEES
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7 Type of Fixture No.
~ Kitchen ..................................
Bath ....................................... $8.00 x
$8.00 x
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Rough-In Bath .......................
$4.00 x
Utility ..................................... $5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
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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
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 ~`. o
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SIGNATURE OF CONTRACTOR 0 AU~ IZED GENT
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TOTAL ~~~ ~ ~
DATE Current License on File s O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) TH S IS YOUR PERMIT
Comment: Approve
POUNDS PRTG: Blair, NE Rav. 12195
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