PL-2010-00041.jpg (2) PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 213
(402) 426 -4191
Application Date: 0-10 Permit Fee: $ ` U
Job Address ( j� 6 1 U S" l �v ! / T
Own e I Mail Address Zip Phone
1. ;frl' rtC�c� S
Contr r it Address Zip // t PhoneL
2. ; �S � 4 A!q�n I �ylJ 5�'/'4 � �� �G b1? 7 VU — L11 S
3. Class or Work: 9&OMMERCIAL CY RESIDENTIAL O New ddition O Alteration O Repair O Replacement
Describe Work: l
4. ����� nPw ✓�' ��4
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
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 J
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
of on actor or Au orized Agent Permit Issuance Fee .................$25.00 U
o
Total Y
i 2,— Current License on File Yes O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10