re-2011-00062_0001.tif PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 1 Street
Blair, Nebraska 68008
Fax ( 02) 426-4195 P 2146
Application Date: Permit Fee: $
Job Address
Owner Mail Address Zip Phone
1.
Contractor Mail Address Zip Phone
2.
3. Class of Work: O COMMERCIAL O RESIDENTIAL O New O Addition O Alteration O Repair O Replacement
Describe Work:
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
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
Sewer ........ .........................$15.00
performance of construction.
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 Permit Issuance Fee .................$25.00
Total
Current License on File O Yes O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
5
Rev. 2008 -10