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Signature PageBUILDING PERMIT DEPOSIT AGREEMENT A $500.0 refundable deposit is being collected for any new commercial, new residential, and any additions, remodels and accessory building valued $10,000 or greater at the time of your building permit application. A $200.00 refundable deposit is being collected for any residential remodel, addition or accessory building valued under $10,000. A $50.00 refundable deposit is being collected for all misc. permits. The City reserves the right to not refund this deposit if any of the following conditions occur during the construction period: TIheft of water service by the plumber, owner, or general contractor. 2 All permits have not been obtained. All required inspections have not been obtained. Occupancy occurs prior to a final inspection. The project is completed without a final inspection being done. 1 Storm Water Management Plan inspection not obtained. (If Required) If any or all of these situations occur during construction, you may forfeit your deposit. I hereby agree to the above conditions and understand that should any or all of the above situations occur, the building permit deposit SHALL be forfeited or discounted upon the discretion of the City of Blair, Building and Inspections Department. Cc(htractor/Owner ri Date CITY +±gR 3e& 166TH y ±gR HE ±me --------------------------------- ---------------- \ NIELSEN mN©F g+� 3796 IR AVE NEW COMM D ±+S m+ƒT s32m ACCOUNT mL CHECK # 7153 NEW § m%Received 2,507m Charge ,m --------------------------------- 9 3/264 a:g 9 132027 Address At, Permit # C N W New Construction Checkoff List Date Received Initials Date Ap proved 1) Building Plans 2) Site Plan 3) ResCheck/ComCheck 4) ResCheck/Comcheck-Deferred until Dried in 5) Water/Sewer Connection Fees (Additional fees apply) 6) Given to Zoning 7) Zoning Approved 8) Site Plan Approved 9) Flood Plan Checked 10) Storm Water Management Report 11) Given to Building Inspector �i 4 A 1+71