M19960112/~~ ~ ~~
Application Date: ~--- ~ ~~-~~
Permit Fee: $ fi
JOB ADDRESS j /~
LEGAL
1 • DESCR. LOT N0. BLK. TRACT
D SEE ATTACHED SHEET
OWNER J' ~ ~„ MpAIL/ADDR S ZIP _ , , PHONE
3. CONTRACTOR M IL ADDRESS PHONE LICENSE N0.
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1,.~' hE~%~--~~~/ic, ~ ~`~4..,a. ° ~Ya,b ~VJ ~ ~._o~~%~~_~L.r^'~~~T - ea,~,;,.~C,
4• Class of Work: D NEW RESIDENTIAL D NEW COMMERCIAL D REMODELING/ADDITIONS REPLACEMENTS
5• Describe Work: '' ~ ~~ ~ ~--
Comments:
~.. MECHANICAL PERMIT FEES
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Forced Air Systems ~~
,~ i~ Per Unit Commercial/Residential (New) ...................................... $25.00
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~~ Air-Conditioner Unit
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, ~ Refrigeration Units/Coolers
Per Unit Commercial (New or Replacement) .............................. $10.00
N®TIC
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
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.
~~ ~.n~. ry
Permit Issuance Fee ............. $15.00 / •~ ° ~~~~ -~
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T®TAL ~ ~ ~
1 ~' _...~ . _---_
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
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Current License on File Yes D No DNA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS,YOUR PERMIT
Comment: Approved By:
,r ~~ r f;
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POUNDS PRTG: Blair, NE ` Rev. 12/95
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