Loading...
P19971002PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 ~ (402) 426-4191 Application Date: l 0 4 "~~ ll ~b Permit Fee: $ ~J JOB ADDRESS - ~ _ GAL 1. DE LOT N0. BLK. TRACT O SEE ATTACHED SHEET 2.OWNE MAILADDRESS ZIP `ON ij~ 3. CONT MA1L ADDRESS L ~ ~0~~ J LICE(JSE N0. 1 o~ / l~ ~ti/ 4• Class of Work: O NEW RESIDENTIAL O N COMMERCIAL O REMODELING/ADDITIONS D REPLACEMENTS 5• Describe Work: Comments: PLUMBING PERMIT FEES 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 Q a rz , NOTICE Sewer .................................... $10.00 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 Sprinkler System ...................$30.00 law regulating construction or the performance of construction. (Commercial) ~ , Permit Issuance Fee ............. $15.00 dU ~ GNATURE OF CONTRACTOR OR AUTHO IZED A NT TOTAL ~~ ~~-S DATE Current License on File OYes O No O NA WHEN PROPERLY VALIDATED (IN THIS SPA(3E~THIS IS YOUR PERMIT POUNDS PRTG.•Blalr, NE Rev. 12/95 ~~iNG INS~'ECTI~N R,EPOI~,T - t „~,-Y OF BLAIR ^ WASHINGTON COUNTY ^ OTHI~ /-.,; LOCATION OF INSPECTIONS /~/ ` r / ~~ ~ j / ~ ~ I NAME OF OWNER,: G~-~ _ CONTRACTOR: '~~`~ %~~ ~ DATE INSPECTION REQUESTED: - FRMI 0: TIME INSPECTION REQUESTED: ~ ~ ~ TYPE OF INSPECTION REQUESTED: BUILDING: ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL UTILITIES: ^ SEWER TAP ^ SEWER EPTIC _ ATER TAP ~ ( ' ^ REMOTE [WATER SER V I CE ELECTRICAL: ^ R©UGH IN ^ FIXTURES ^ FINAL ^ MOTORS ^ PERMANENT SERVICE ^ TEMPORARY SERVICE MECHANICAL: ^ ROUGH-IN ^ A/C ^ FINAL :: PLUMBIN(~~` ^ GROUNDWORK ^ ROUGH-IN ^ FINAL RESULTS OF THE INSPECTION~t-'xbS~D (sue NorES~ ^ FAILED csEE No~rns> NOTES/REMARKS: DATE OF INSPECTION u~~: CALLED OPPD\ TO CONNECT SERVICE: WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO ^ YES ^ NO BLR 1