P19960115l- ~c"' ~'
Application Date: r` ~ ~ ~'
Permit Fee: $
JOB ADDRESS /~
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
®SEE ATTACHED SHEET
OWNER ~ ~ > _ // MAIL ADDRESS ZIP PHONE
CONTRA~T R MAIL ADDRESS
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4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS EPLACEMENTS
5• Describe Work: ~ ~~ ~ ~ ~ ~ ~~ ~,~ ~, ~ ~ ~~~~,
Comments: ~~
PLUMEINC PERMIT FEES
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Type of Fixture
No.
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\ Kitchen .................................. $8.00 x
~0 B
th $8
00
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....................................... .
x
~G Rough-In Bath ....................... $4.00 x
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Utility .....................................
$5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ~ C!i.,
$10.00 f C-
NOTICE Sewer .................................... $10.00
I 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
Sprinkler System ...................
$30.00
law regulating construction or the performance of (Commercial)
construction. ~ ~
Permit Issuance Fee $15.00 ~ ~ ~~ ~~~~~
IGNA RE OF CON A TOR OR AUTHORIZED AGENT
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TOTAL
DATE Current License on File OYes ®No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG.•Blair, NE Rev. 17195
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^~CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: f ~ ~ ~ ~?~{"f ~" ' ~~ ~~ " ° n~~
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NAME OF OWNER: r1 ~r '~~~I-~%~ S CONTRACTOR: t /~~~~ ~r~7Oi..y.~/
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DATE INSPECTION REQUESTED: ~ "- ~ ~~ ~ % ~~ PERMIT NO: ~'
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TIME INSPECTION REQUESTED: ~ ~ ~~ I j}`v~~~~ ,
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TYPE:OF INSPECTION REQUESTED: ~~~~~ 9tU~ r~ ~~~
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BUILDING: ° o, ~ , ~`~
^ FOOTING ^' FRAMING ^ DRYWALL ^ FINAL ~Li (~ .
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UTILITIES: J
SEWER TAP ^-SEWER
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^ WATER SERVICE
ELECTRICAL: ~<
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^ ROUGH IN ^ FIXTURES ^ FINAL ~ ^ MOTORS
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ROUG~~IN ~.?~ ~ FINAL
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GROUNDWQRK ^ ROUGH-IN ^ FINAL
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