SA-2012-00319_0003.tif Cit of Blair Due Invoice Summary
218 S 16th Street Page 1 of 1
Blair, NE 68008
" DATE 8/812012
I pl 0� Phone: (402) 426 -4191
Fax: (402) 426 -4195
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ACCOUNT:
American Lift & Sign
6958 N 97th Cir PERMIT NUMBER SA -2012 -00319 E
Omaha NE 68122
718 S 19th St
Phone: 402- 572 -1044 BC HUBER'S ADD PART OF LOT 7 114 PC 7
Blair, NE 68008
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Date Reference Number Invoice Number FeeCat Description Status Amount
8/712012 SA- 2012 -00319 2012 -01057 0100042024 Building Permit Fees Due 70.00
8/7/2012 SA- 2012 -00319 2012 -01057 0100042024 Building Permit Issuance Fee Due 25.00
8/712012 SA- 2012 -00319 2012 -01057 01- 002 -2450 Building Permit Deposit Due 50.00
Total Due 145.00
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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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