P19970804
Application Date;
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Permit Fee: $ ~ 9
JOB ADDRESS ~ ~ I• ~ v t r ~ ~~` ~ , j
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1 LEGAL
DESCR. LOT N0. BLK. TRACT O SEE ATTACHED SHEET
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PHONE
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MMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
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s of Work: O NEW RESIDENTIAL O NEW CO
5• Describe Work:
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Comments: PLUMBING PERMIT FEES
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Type of Fixture Mo.
Kitchen .................................. $8.00 x
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Bath .......................................
$8.00 x
t Rough-In Bath ....................... $4.00 x
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~,~ Utility .....................................
Water Heater ......................... $5.00 x
$3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ........................ $10.00
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 , , l~, i,~y
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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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l , Permit Issuance Fee ..... ~:.... . $15.00 y ~~ r~
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SIGNATU OF CON ACTOR AUTHO ZED AGENT
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TOTAL
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`_ ~; Current License on File es O No ®NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: I Approved By: ~` ;:: ,~~ ~/'~
POUNDS PRTG: Blair, NE ~ Rav. 12/95
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r I INS CT
~~ CITY OF BI;AIR [] WASHINGTON COUNTY [~ OT'HER
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LOCATION OF INSPECTION: ~ ~~ ~~~ s~ ~~ - ? ~~ L g r ;~'~ ~~- j f. J ~, f r.--
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NAME OF OWNER: ^i '~~',.i ~ '3'3 r'',~~~:':_' ii' ~' ~ f? °~-~ ~'/~ , ~,
CONTRACTOR: ~.- ~~--~ + ~-, ;s
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t DATEINSPECTIONREQUESTED: ~~ ~° -~` { ~ PERMIT NO:
E TIME INSPECTION REQUESTED: ~~1 •-' r ~•
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f
~ TYPE OF INSPECTION REQUESTED:
BUILDING:
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^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
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F UTILITIES:
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~; []SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP 1
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^ REMOTE ^ WATER SERVICE
ELECTRICAL:
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^ ROUGH IN ^ FIXTURES ^ FINAL ~ MOTORS i
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
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~ MECHANICAL: 4 -,~~ I;~,
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^ FINAL ,~
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PLUMBING: --- ° ,
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k_ [~~GROUNDWORK []ROUGH-IN ~ FINAI, ~~
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_ RESULTS OF THE INSPECTION: • PASSED EsEa xoTES~ ^ FAII.,ED ~sES xorESi
NOTES/REMARKS:
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