M19960212MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
~ 9~ Permit Fee: $ °?~-~Z3
Application Date:
JOB ADDRESS ~~ ~,3 ~ ~ ~' ._
V/
LEGAL
t LOT NO. BLK. TRACT O SEE ATTACHED SHEET
' DESCR.
py~ AIL ADDR SS ZIP PHONE /' ~j
2
ON OR MAIL ADDRESS P~ ~ /
,3 CENSE N
. ~'~ .
4• Class of Work: O NEW RESIDENTIA O N COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5. Describe Work:
Comments:
MECHANICAL PERMIT FEES
Forced Air Systems
Per Unit Commercial/Residential (New) ...................................... $25.00
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 Forced Air Systems/Air Conditioner Q~
application and know the same to be true and correct. All Unit Replacement ~~
provisions of laws and ordinances governing this type of
Per Unit Commercial/Residential (Replacement)
........................ $10.00
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
rmance of
th
f
ti
e per
o
on or
law regulating construc
construction.
Permit Issuance Fee ............. $15.00 ,` j
~S ~~
TOTAL
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
Current License on File Yes O No
O NA
DATE
WHEN PROPERLY VALIDATED (IN THI~HIS IS YOUR PERMIT
Comment:
Rev. 12/95
FUNDS PRTG.-Blair, NE