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PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16' Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 2100
(402) 426 -4191
Application Date: °a? 9W At
Job Address / � / f /�)
Owner ail Address zip Phone
a
ontractor
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.;An Q 101 rail
2 � ;� G1 !`r • GT G✓ c� p / �L
3. Class of Work: 0 COMMERCIAL ESIDENTIAL V 10 New O Addition O Alteration O Repair d R eplacement
Describe Work:
4. p 14)
PLUMBIN PERMIT FEES
Comments:
Modular Horne ............. . ........$50,00
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath.,...Residential/Single Stall $12.00 x
.... ..............Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x
Additional Sinks .....................$6.00 x
Slop Sink/Laundry Thy/Drain ..... $6.00 x
Water Heater .........................$10.00 x
Notice
Outside Water Faucet ...................$6.00 x
I hereby certify that I have read and examined this
Drinking Fountain x
application and know the same to be true and correct. All
........................$6.00
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
� J1"
Backflow /Grease Tra l? $15.04 . 160
not. The granting of a permit does not presume to give
_
authority to violate or cancel the provisions of any other
Water Service .......................$15.00
state or local law regulating construction or the
performance of construction.
Sewer ........ .........................$15.00
Groundwork ......................... $15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
( Commercial ) ........................$50.00
gnanire of ontractor or Authorized Agent
Permit Issuance Fee .................$25.00
Total
Jai
Current License on File 4KYes 0 No O N/A
Date
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACEYTHIS IS YOUR PERMIT
Approved By:
Rev
/ VO, > i
s /
2008 -10
v [ ,
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195
(402) 426 -4191
Application Date: ',9 9 /�)
P 2100
Permit Fee: $
0 . 00
Job Address / J Z1 / �°
Owner Mail Address Zip Phone
1.
Contractor � ailt� o /4 /' a/l al
/
3. Class of Work: ❑ COMMERCIAL RESIDENTIAL O New 13 Addition O Alteration O Repair O Replacement
4
Describe Work: �C 14.) ?
PLUMBIN PERMIT FEES
Comments: Modular Home ......................$50.00
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath.....Residential /Single Stall $12.00 x
...... ..............Multi -Stall $25.00 x
Rough -In Bath ........................ $8.00 x
Additional Smks ..........$6.00 x
Slop Smk/? y/Drain ..... $6.00 x
W ........$10.00 x
Notice s ......$6.
00 x
N
I hereby certify that I have read and exammf' $6.00 x
application and know the same to be truen f
provisions of laws and ordinances gr r '
work will be complied with w1 $15,00
not. The granting of a permit
authority to violate or cancel the
state or local law regulating cc '
performance of constr" t?0
i
........ $50.00
r „�
Signature of Contractor or Authorized Agent �r r .,,e Fee .................$25.00 a96 0 0
Total 00
�Cirrent License on File 4WYes O No O N/A
Date Comment: �y
WHEN PROPERL Y V ALIUA l EL) (1N l HlN aFAUhy I Hn I�) Y v u x rr,tuv" l
Approved By: & ';��
Rev. 2008 -10