E0096Application Date: ~ ~rv ~~
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. fit. x .045
N®TICE
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
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.
~~" " SIGNATURE OF CONTRACTOR OR HORIZED AGENT
~. ° i ~~~
DATE
Receptacle/Switch Outlets
Fixtures x $.75
Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
# Apparatus x $3.00
Permit Fee: $ `
f-~~
Permit Issuance Fee ............. $15.00
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PER T
Comment: Approved Oy: r
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POUNDS PRTG: Blair, NE ~ Rev. 12/95
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~~ ^ CITY pF BI;AIR ^ WASHINGTON COUNTY . ^ OTHER
- r LOCATION OF INSPECTION: =~~ ~1-"`~ ='~- ~~ ~ ~`'~'
~: ~`,~ ~;
t NAME OF OWNER z'=-- - - ~`J~~ i f'.~. CONTRACTOR:
~~° ~ ~~-~'~~ i
'~3 ~PERMITNO: ~ ~ '
DATE INSPECTION REQUESTED ~~~~'~1'~?
~
TIME INSPECTION REQUESTED
t, ;
E TYPE OF INSPECTION REQUESTED:
k.-
BUILDING:
~.
^ FOOTING ^ FRAMING
,.... ,
^ DRYWALL ^ FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ~ ^ SEPTIC ^ WATER TAP
-
-
^REMOTE .. ^ WATER SERVICE
ELECTRICAL: -
;~ ^ ROUGH IN ^ FIXTURES FINAL ^ MOTORS
PERMANINT SERVICE , ^ TEMPORARY SERVICE
MEGHAMCAL:
ROUGH IN 0 A/C ^ FINAL
PLUMBING:- .
^ GROUNDWORK ~~ ' ~-
. - __
^ ROUGH,IN ^ FINAL
`!
..
- -!~
RESULTS OF THE INSPECTION:
_ `PASSED (s~xoTES) ^FAILED (s~xo~s) io
Y
F ` ' NOTES/REMARKS: - {
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