PL-2010-00007.tif PLUMBING PERMIT A PPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 2136
(402) 426 -4191
Application Date: Permit Fee: $
Job Address
Owner e Mail Address Zip Phqne
Contractor Address Zip Phone
2. ��
3. Class of Work: O COMMERCIAL ESIDEN L New O Addition §1 Alteration O Repair O Replacement
Describe Work: d
4. j 1440 il
PLUMBING VERMIT FEES
Comments: Modular Home ......................$50.00
Type of Fixture No.
i
I
Kitchen ..... .........................$12.00 x
i
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 Tray/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
application and know the same to be true and correct. All Drinking Fountain ........................$6.00 x
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or Backflow /Grease Trap 15.00
not. The granting of a permit does not presume to give p
authority to violate or cancel the provisions of any other Water Service .......................$15.00
state or local law regulating construction or the
Sewer ........ .........................$15.00
performance of construction. sr
Groundwork .........................$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
Sprinkler System (Commercial).. $3 0.00
Gas /Water Piping System
(Commercial) ........................ $50.00
Signature of Contractor or Authorized Agent Permit Issuance Fee .................$25.00 ��✓
Total
Current License on File es O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: J
Rev. 2008 -10
i