INVOICE.TIF Nov. 9, 2012 3:25PM CITY OF BLAIR (402.426, 4191) No, 7916 P. 1
city of flair Due Invo Summary
216 5 Page 7 of
16th Street 1
Blair, NE 68008 DATE 11/9/2012
i
Phone: (402) 426 -4191
Fax: (402) 426 -4195
ACCOUNT:
Complete Comfort Heating Coaling
5012 Leavenworth rJ600 MBER ME- 2012 -00520
Omaha NE 66106 shington St
28 - 0 BLK 37114 PC 19 Phone: 402 8271827 , 68008
StaiuS
Dale RoferenceNumber Invoice Number FeeCat Description Amount i
11!9/2012 ME -2012 -00520 2012 -01324 0100042027 Mechanical Fixture Fees Due 50 - 2500
11/9/2012 MF - 2012 -00520 2012 -01324 0100042027 Mechanical permil issuance Fee DUO
Total pue �s.00
I hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws.
gnature of Contractor or Authorized Agent
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