M19960521Application Date: ~'~ ~'
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Permit Fee: $ ~~~ A~.~
JOB ADDRESS ~~°°
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1 LEGAL
DESCR. LOT NO. BLK. TRACT O SEE ATTACHED SHEET
OWNER MAIL ADDRESS ZIP ~ , y ,- - ~~ HONE
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3 CONTRA OR ~ ~ MAIL ADDRESS - PHQNE LICENSE NO.
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4. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS REPLACEMENTS
5. Describe Work:
Comments:
MCFI,4NICAL PERMIT FEES
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Forced Air Systems ~` °~
Per Unit Commercial/Residential (New) ...................................... $25.00
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~ ~~° ~~~ ~ ~~ Air-Conditioner Unit
...................................... $10.00
Per Unit Commercial/Residential (New)
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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 ~ ~~ f~tfli
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.
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Permit Issuance Fee ............. $15.00 ~ ~ , ~ ~-
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V
im' SIGNATURE OF CONTRACTOR~R~~UTHORIZED~ GENT
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~_ Current License on File Yes ®No O NA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ,
POUNDS PRTG: Blair, NE ~ Rev. 12/95
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w~ ~ UrHiC~; J'1'Arr' "1'U CALL OPPD\ U YES [] NO BLR 1 j
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