PL-2010-00013.tif i
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APPLI PLUMBING PERMIT
Jurisdiction of City of Blair, Nebraska
1 �3
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 2137
(402) 426 -4191
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Application Date: 2--( 1 ( Permit Fee: $ I co
Job Address g
o o J" Cc) C h i (J
Owner Mail Address Zip Phone
Contra r Mail Address Zip Phone
3. Class of Work: O COMMERCIAL O RESIDENTIAL O New O Addition O Alteration O Repair O Replacement
Describe Work: 1
PLUMBING PERMIT FEES
Comments: Modular Home ......................$50.00
Type of Fixture No.
Kitchen .............. .
3 t
...............$12.00 x
Bath.....Residentia &WStall $12.00 x
...... ..............Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x
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Additional Sinks.......... ......... $6.00 x oo
Slop Sink/Laundry Tray/Drain ..... $6.00 x ( (". j
Water Heater .........................$10.00 x Q
Notice Outside Water Faucet ...................$6.00 x
I hereby certify that I have read and examined this S
application and know the same to be true and correct. All •.... .... $6.00 x '0
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
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
/Signature of Contractor or Authorized Agent g Permit Issuance Fee .................$25.00
Total
Current License on File 2 Yes O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10