P19960925Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
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Application Date: ~ ~' -~ ~~ ~'
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Permit Fee: $
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1. LEGAL
DESCR. LOT NO. BLK. TRACT ®SEE ATTACHED SHEET
OWNER -~. 1 ~ ~ MAIL ADDRESS
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CONTRACTOR .~ ~~- - MAIL ADDRESS PHONE s ,._
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i LICENSE NO.
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4. Class of Work: 8 NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS REPLACEMENTS
5. Describe Work:
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Comments:
PLUMBING PERMIT FEES
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~ Type of Fixture No.
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~ Kitchen ............................ ......$8.00 x
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`" ~6 Bath ....................................... $8.00 x
Rough-In Bath ....................... 4.00 x
Utility ............................... ...... $5.00 x
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~ Water Heater $3.00 x
` Outside Water Faucet ..... ...... $3.00 x
Water Service ........................ $10.00
N®TIC Sewer $10.00 ~ ~ti~ ~ ~'~
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.
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Permit Issuance Fee ............. $15.00 <~
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SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
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DATE Current License on File QF~es ®No ®NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
Approved By: ~~` ~ '~
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POUNDS PRTG: Blair. NE Rev. 12/95
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a' CITY- OF BLAIR ^ WASHINGTON COUNTY ^ OTHER ~
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LOCATION OF INSPECTION: ~ `~~ ~ ~='~~ ~~~~
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NAME OF OWNER; ~ j ~~~~~ CONTRACTOR: `~`~ ~ ~r ~ 1
DATE INSPECTION REQUESTED: f ~ ~ ~ ~~ PERMIT NO: ~t'~ ~~ `
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TIME INSPECTION REQUESTED: ~ ° '-'~
TYPE OF INSPECTION REQUESTED:
BUILDING:
' ^ FOOTING ~^ FRAMING ^ DRYWALL ^ FINAL
TILITIES: r.,~.-_-
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^ SEWER TAP ~~" `
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0 SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN . ^ FIXTURES ^ FINAL ^ MOTORS
f ^ PERMANIN
i T SERVICE ^ TEMPORARY SERVICE