P19960116~~
Application Date: ~ ` I
Permit Fee: $ ~ ~ ~~~
JOB ADDRESS
LEGAL
1 • DescR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
,Z OWNER ,_s ~' '~ ((,, MAILADDRESS
~~~~~~ V ZIP PHONE
CONTRACTOR MAIL ADDRESS
3. ~ ~ ~ ~-~ PHONE LICENSE NO.
4. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDI
TIO
NS REPLACE
MENTS
5. Describe Work: 0~~ (.~' ~Cd ~~ ~ i'~~ ~~ ~~ ~1 C~~1'1 ~® ~
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Comments:
PLUMBING PERMIT FEES
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Type of Fixture
No.
( Kitchen .................................. $8.00 x
Bath ....................................... $8.00 x
Rough-In Bath .......................$4.00 x
Utility ..................................... $5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service $10.00 ~,
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NOTICE Sewer .................................... $10.00 ~ !~-
I hereby certify that I have read and examined this
Groundwork ...........................$10.00 ~,.
,_
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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 ~ P~~ ~ :~`°~ \,
"~'~ ~ ~
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.
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-
Permit Issuance Fee .............$15.00
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-' SIGNATURE OF CONTRACTOR OR ~ `~+Z~D AGENT
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DATE Current License on File OYes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS ly$`I~OUR PERMIT
Comment: I Approved By: _ _~~r ~9
POUNDS PRTG: Blair, NE ~~ Rev.12/95
,~.~,-_._ ~ ~ I
' ~ '''CITY OF BLAIR WASHINGTON COUNTY ~ OTHER
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- ~,OCATION OF INSPECTION: ~t (,~~ ~ri i' ~~
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. NAME OF OWNER: ~1%'(~1~1 ~:"' ~LYt`~ j ~ ~ CONTRACTOR: 7~`~~ C~
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DATE INSPECTION REQUESTED: ~ ' ° -%~ ~' ~ PERMIT N0: ~
~ TTME INSPECTION REQUESTED: ~ - ~ ' .~'~°'
:_ ..
TYPE OF INSPECTION REQUESTED:
.. ,
BUILDING:
[~ FOOTING ^ FRAMWG , ~ DRYWALL. Q FINAL
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~ UTILI-TIES: ~
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Q'SEWER TAP 0 SEWER ~ SEPTIC '~ ATER TAP
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REMOTE '~}`~VVATER SERVICE
i ~,s. ; /`
e ELECTRICAL
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ROUGH IN Q FIXTURES ^ FINAL ~ MOTORS
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PERMANENT SERVICE Q TEMPORARY SERVICE _ j
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~ `MECHANICAL:
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~" ~ ROUGH-IN ^ A/C ~ FINAL
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PLUMBING:
('
I [] GROUNDWORK Q ROUGH-IN ~ FINAL
RESULTS OF THE INSPECTION: ASSED ~sEENOTES7 ^ FAILED csEE rro~rES~
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NOTF4/RRMARK.C•
DATE OF INSPECTION MADE:_ - / ~ OC~g s- TIME: ~ `ry l._.~
` CALLED OPPD\ TO CONNECT SERVICE: Q YES ^ NO
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_`WANT OFFICE STAFF TO CALL.OPPD\ ~. YES -. 0 ?PTO BLR 1 ' J
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