PL-2010-00041.jpgPLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 2138
(402) 426 -4191
Application Date: Permit Fee: $ U
Job Address
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Own e I Mail Address Zip Phone
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Contr r M�aij Address ! r/ � ( p 1 x �p / G i Phone V r /
3. Class o Work: OMMERCIAL RESIDENTIAL O New ddition O Alteration O Repair O Replacement
Describe Work:
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PLUMBING 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 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
Drinking Fountain ........................$6.00 x
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
Backflow /Grease Tra " " " "" $15.00
p '
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
of on actor or Au orized Agent
Permit Issuance Fee .................$25.00 lv
2
Total
i
Current License on File Yes O No O N/A
Date
Comment:
WHEN PROPERLY VALIDATED (IN THIS SP
Approved By:
THIS IS YOUR PERMIT
Rev. 2008 -10