P19961021PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: j () ~ Z ~+
Permit Fee: $
JOB ADDRESS
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LEGAL
1 • DescR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
2. OWNER ~~~ ~~ ~~ ~~~ MAILADDRESS ZIP PHONE
3• CONTRACTOR\~ ~ ~ MAILADDRESS
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4• Class of Work:
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LING/ADDITIONS ~EPLA
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EMENTS
5• Describe Work: i ~ ~,~ ~ ~~ ~ ~~
Comments:
PLUMBING PERMIT FEES
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~u~ti 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
NOTICE Sewer .................................... $10.00 _~ ~ U • C~
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
law regulating construction or the performance of
Sprinkler System ................... $30.00
construction. (Commercial)
Permit Issuance Fee .............$15.00 ~ S. UCH
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
TOTAL
~ S, d U
DATE Current License on File Yes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
POUNDS PRTG: Blair, NE I / Rev. 12!95