M19970509MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: `~~ ~~
~ dCJ
Permit Fee: $ --~~"
JOB ADDRESS ~ ~ / ~\_L1A ~~-
V 1 ~ ~
LEGAL
1 • DescR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
OWNER
2. e MAIL ADDRESS
~~. ~ 'Q. ~ ZIP
~l z. ~ i PHONE
3• CONTRACTOR , n ~ MAIL ADD
` SS ~ ~ ~ _PJ,iOt~C`~ ~~ ~
l r LICEt~I,S~NO_ ~~~
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4• Class of Work: O
E
W RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS
N EP
L
ACEMENTS
5• Describe Work:
Comments:
MECHANICAL PERMIT FEES
`~ ~~~ ~iY
J Forced Air Systems
5 `i3 ~t1 Per Unit Commercial/Residential (New) ................ ...................... $25.00
~
l Air-Conditioner Unit
Per Unit Commercial/Residential (New)
$10
00
~
`~~ ................ ......................
.
Refrigeration Units/Coolers
Per Unit Commercial (New or Replacement) ........ ...................... $10.00
NOTICE
I hereby certify that I have read and examined this
a
lication and know the same to be true and correct
All Forced Air Systems/Air Conditioner "~ ~1
~
pp
. Unit Replacement G
" `~-~
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
Per Unit Commercial/Residential (Replacement) ..
...................... $10.00
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.
Permit Issuance Fee ............. $15.00 Q
~ ~ ~ ~
TOTAL ~~- QU
v
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
Current License on File Yes O No O NA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOl~1PERMIT
I Comment: I Approved By: ~ ~~~
POUNDS PRTG: Blalr, NE ~/ Rev. 12!95