PAID INVOICE.TIF i
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City of Blair Paid Invoice Summary
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218 S 16th Street Page 1 of 1
Blair, NE 68008 DATE 11/14/2012
� Ise ° Phone: (402) 426 -4191
Fax: (402) 426 -4195
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ACCOUNT:
McKinnis Roofing & Sheet Metal
164 S 1st St PERMIT NUMBER MS- 2012 - 00514
Blair NE 68008 910 Skyline Dr
Phone:402- 426 2644 BC TYSON'S SKYLINE ADD L 5 116 PC 5 2.14 AC
Blair, NE 68008
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Date ReferenceNumber Invoice Number FeeCat Description Status Amount
11/14/2012 MS -2012 -00514 2012 -01334 01- 002 -2450 BuildingPermitDeposit Paid (-) 50.00
11(1412012 MS -2012 -00514 2012 -01384 01- 009 -4264 Building Permit Fees Paid (-)25.00
11/14/2012 MS- 2012.00514 2012 -01334 01409.4264 BuildingPermitFees Paid (-)40,00
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Date InvoiceNum Status Payment Amount
11/14/2012 2012 -01534 OriginatDue 115'00
11/14/2012 2012 -01334 Paid Check32207 (- )115.00
Total Paid 115.00
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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
ppovlsions of laws.
Signature of - C ntractor or Authorized Agent
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