PL-2011-00101.tif F City of Blair Due Invoice Summary
218 S 16th Street Page 1 of 1
�,. Blair, NE 68008
DATE 4/11/2011
Phone: (402) 426 -4191
Fax: (402) 426 -4195
ACCOUNT:
Service One
9335 "j" St PERMIT NUMBER PL- 2011 -00101
Omaha NE 68127 2106 Grant St
Phone: 402- 339 -4357 BC LOTS 11 12 PT OF VAC ST BLK 101 113 PC 8
Blair, NE 68008
Date Reference Number Invoice Number FeeCat Description Status Amount
4/1/2011 PL- 2011 -00101 2011 -00680 0100042026 Plumbing Fixture Fees Due 10.00
4/1/2011 PL -2011 -00101 2011 -00680 0100042026 Plumbing Permit Issuance Fees Due 25.00
Total Due 35.00
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I hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws.
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Signature of Contractor or Authorized Agent
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