BPP19960926PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: I '-~~o `- / ~r~.
Permit Fee: $ ~~'~
JOB ADDRESS
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1, LEGAL
DESCR. LOT NO. BLK. TRACT O SEE ATTACHED SHEET
OWNER J~ MAILADDRESS
2. (~~ n ~~<_~CA~ ZIP ~~r`~~N
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3. CONTRACTOR /'~~,~`~~ r m ~ ~~~ ~ L ADDcRESS ~ ~ / ~ /~T J • PHONE /~~~ ` / ~~ LICENSE N0. -/ ~~
4• Class of Work: NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5• Describe Work: L-~J~ ~~~~-
Comments:
PLUMBING PERMIT FEES
Type of Fixture No.
Kitchen .................................. $8.00 x
f U Bath ....................................... $8.00 x
~ ~ ~ Y~ Rou h-In Bath
g ...................... $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
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
law regulating construction or the performance of
Sprinkler System ...................
$30.00
construction. (Commercial)
Permit Issuance Fee ............. $15.00 / ~ ~~.~
SI ATURE OF CONTRACTOR AUTHORIZED AGENT v
//
TOTAL ~~ =~
~
AT~
Current License on File O Yes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
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SOUNDS PRTG: Blair, NE Rev. 1?J9: