RN-2012-00352_0006.tif AppLICATION
pLUWING PERMIT
jurisdiction of City
of Blair, Nebraska
218 South 16'
Street
Blair, Nebraska 68008
Fax (402) 426 -4195, ,6.
(402) 426 -4191
0 p
Permit Fee: $
Application Date:
Job Address Phone
Zip
Owner Mail Address
Zip Phone
1 • Mail Address
Contractor
2• j
3. Class of Work: O COMMERCIAL O RESIDENTIAL O New 0 Addition D Alteration ❑Repair O Replacement
I
Describe Work:
4. PLUMBING PERNIIT FEES
Modular Home..".... ............. No.
Comments: Type of Fixture i
Kitchen ............. .. $12.00
................... ......$12.00 x _
Bath,,, :.ResidentiaUSingle Stall $12.00 x .
, , .....Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x
Additional Sinks .................... •$6.00x 1
Slop Sink/Laundry Tray/Drain ..... $6.00 x •
Water Heater .................... $
10.00 x �'
Outside Water Faucet ...................$6.00 x cl _
Notice $6.00 x
I hereby certify that I have -read and e xamined this D in gFountain .................••••••
application an d know the same to be true and correct. All
provisions of laws and ordinances governing this type of $15.00
work will be-complied with whether specified herein or Bacicflow /Gxease Trap
not. The granting of EL permit does not presume to ice ........:...:.........$
authority to violate or cancel the provision other Water Sery
s of any „$15.00 '
state or local law regulating construction or the Sewer .........................
performance of construction. 15,00
G , ...•••••.•••• ........ $ '
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.0 __
Sprinkler System (Convnercial)..$
Gas/Water Piping System
(Commercial) .....................$50.00
Signature - of Contractor or Authorized Agent Permit Issuance Fee.......... , . • • • •'$25'00 Total
Current License on File 13 Yes ❑ No O N/A
Date Comment'.
CE THIS IS YOUR PERMIT
yti �:t: WIN PROPERLY VALIDATED (]N THIS SPACE)
proved By:
2008 -
Rev. 10
+ � n � Y �, y. ��� ; � l , r _ 5` � ..,•
��- ��, �- ..�:.�-. Vie• ..
` • `�yk� j �v4."�E�i';kV,'s,'; ?'�"..cl t ,.u:l�. S: