P19971002Jurisdiction 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:
JOB ADDRESS 7
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LEGAL
~ • DESCR. LOT N0. BLK. TRACT
17 SEE ATTACHED SHEET
2. 0 ER MAI DDRESS ZIP ~ - H E `
C N TOR MAIL ADDRESS ~ d PHONE, LIEENSE N0.
4• Class of Work: O NEW RESIDENTIAL O N COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5. Describe Work: ~% ,~ --~ ~.. ,•~e ~~. .~-
Comments:
PLUMBING PERMIT FEES
Type of Fixture
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
N®TIC
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
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.
OF CONTRACTOR OR AUTHORIZED AGENT
DATE
Water Service ........................ $10.00
Sewer .................................... $10.00
Groundwork ........................... $10.00
Septic Tank & Laterals ..........$10.00
Lawn Sprinkler System..........$10.00
Sprinkler System ................... $30.00
(Commercial)
No.
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WHEN PROPERLY VALIDATED (IN THIS SPA - THIS IS YOUR PERMIT
Comment: Approved By: ~ ~,
POUNDS PRTG.-Blair, NE Rev. 12/95
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D,,CPTY O.F. BLAIIt ^ WASHINGTON COUNTY ^ OTHER ?
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DATE INSPECTION REQUESTED.
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ERMI N0: a
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TIME INSPECTION REQUESTED: ~r • tr ~-~
TYPE OF INSPECTION REQUESTED: ;
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BUILDING: s
3
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^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
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UTILITIES:
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^ SEWER TAP ^ SEWER
EPTIC WATER TAP
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t ^ REMOTE ;' ~JATER SERVICE
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~,; ELECTRICAL:
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^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ~ i
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^ PERMANINT SERVICE ^ TEMPORARY SERVICE j I
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f MECHANICAL:
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^ ROUGH-W ^ A/C ^ FINAL
PLUMBING: I
~' ^ GROUNDWORK ^ ROUGH-IN ^ FINAL '!? ~
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RESULTS OF THEINSPECTIO SED (sEErro~rES) ^ FAILED (sEExo~s)
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NOTES/REMARKS:
E. INSPECTOR:
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DATE OF INSPECTION MADE: ~ `"~ ~ TIIv
CALLED OPPD\ TO CONNECT SERVICE:
WANT OFFICE STAFF TO CALL OPPD\
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^ YES ^NO~
^. YES ^ NO 6LR 1