BPM19970414MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: L~ _ ~ ~I C
Permit Fee: $
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JOB ADDRESS ~ ` r ~ ~ J ~ ~h ~_/
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LEGAL
1 • DescR. LOT NO. BL
K. TRACT
O SEE ATTACHED SHEET
2. OWNER f `~ ~ MAILADDRESS
L I~ I O +/~,~ ZIP ~r
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3. CONTRACTOR ~ I lord ~I ~ C ( AID ILADDRnS
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'~ PHONE LICENSE NO.
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4• Class of Work: `NEW RESIDENTIAL O
COMMERCIAL REMODELING/ADDITIONS O REPLACEMENTS
b• Describe Work: ~~ h/<~r/~ ~~ I(~U OOC ~ / () ~GC~/J~ ,, 7()rl {'~~~
Comments:
MECHANICAL PERMIT FEES
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~ ~ Forced Air Systems
Per Unit Commercial/Residential (New) .................
..................... $25.00
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Air-Conditioner Unit
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r Per Unit Commercial/Residential (New) 10.00
Refrigeration Units/Coolers
Per Unit Commercial (New or Replacement) ......... ..................... $10.00
NOTICE
I hereby certify that I have read and examined this Forced Air Systems/Air Conditioner
application and know the same to be true and correct. All Unit Replacement j Q ' C~
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
f ~ ~ ~
TOTAL ~Jr • U p
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
_., ~~, ~ 7
Current License on File O No ~` • O NA
/ '
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS XOUR PERMIT
Comment: Approved By: ,~'
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POUNDS PRTG: Blalr, NE / / Rev. 12/95
9