PL-2010-00008.tif i
PL UMBING PERMIT A PPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 T 1375
(402) 426 -4191
do a 00
Application Date: '° Permit Fee: $
Job Address
Owner ` Mail Address Zip Phone
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Contractor Mail Addre s Zip Phone
2.
3. Class of Work: O COMMERCIAL ESIDENTIAL r View O Addition O Alteration O Repair O Replacement
Describe Work: o
4.
PLUMBING PERMIT FEES
Comments:
Water Tap Fee — % $150.00
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Water Tap Fee —1" $200.00
I hereby certify that ha e r ad and examined this Water Tap Fee —1 V2» $250.00 j
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of T
work will be complied with whether specified herein or Water Tap Fee — 2 $300.00
not. The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
performance of construction.
1 � �
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Signature of Contractor or Authorized Agent j
Total ® , 0.
Current License on File es O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: .
Rev. 2008 -10
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