SIGNED PAYMENT INVOICE.TIF i
Nov. 3. 2012 11:25AM CITY OF BLAIR (402.426.4191) No. 7396 P, 1
city of Blair
Due Invoice Summary
218 S 161h Street ` Page 1 or 1
Blair, NE 68008 (vt{ {n' ` DATE 11/6/2012
Phone: (402) 425 -4191
Fax: (402) 426 -4195
ACCOUNT:
A 1 Unitod Heating & Air Conditioning
4972 F St PERMIT NUMBER ME- 2012 -00515
Omaha NE 68117 208 Arthur St
BC WEIMERS ADD LOT 24 115 PC 7
Phone: 402 593 7500 Blair, NE 66008
i
Date Reference Number InVOIcaNumber FeeCal Descriplion stallis Amount
111612012 ME- 2012 -00515 2012 -01318 0100042027 Meohanlcal Fixture Fees Due 65.00
11/612012 ME- 2012 -00515 2012 -01316 0100042021 Mechanical Permit lsBuanwFos Due 25.00
Total Due 90.00
I hereby certify that I have read a examined this application and know the same to be true and correct. All
provislo s of laws.
Signature of Contractor or Authorized Age t
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