RN-2012-00393.tif CITY OF 9 NEBRASKA
Phone 402- 426 -4191
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RECEIVED OF:
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CITY, STATE, ZIP CODE J
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THANKYOU KEEPTHIS COPY FOR YOUR RECORDS.
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RECEIVED BY
Pounds Printing, . Blau, NE 68008
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City of Blair Paid Invoice Summary
218 S 16th Street Page 1 of 1
Blair, NE 68008
DATE 4/24/2013
a ` °A+ise °f a ° Phone: (402) 426 -4191
Fax: (402) 426 -4195
ACCOUNT:
J Nielsen Construction LLC
1730 State St PERMIT NUMBER RN- 2012 -00393
BLAIR NE 68008 -1568 13745 Spring Ridge Loop
Phone: 402 426 2059 SPRING RIDGE LOT 16 12K PC 16 2.00 AC
`Blair, NE 68008
Date Reference Number Invoice Number FeeCat Description Status Amount
9/21/2012 RN- 2012 -00393 2012 -01167 0100020229 Building Permit Deposit Paid (- )500.00
9/21/2012 RN- 2012 -00393 2012 -01167 0100042024 Building Permit Fees Paid ( -) 1350.00
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9/21/2012 RN -2012 -00393 2012 -01167 0100042024 Building Permit Issuance Fee Paid (- )25.00 1
Date InvoiceNum Status Payment Amount
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9121/2012 2012 -01167 Original Due 1875.00
9121/2012 2012 -01167 Paid Check31902 ( -) 1875.00
Total Paid 1,875.00
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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.
Signature of Contractor or Authorized Agent
Save Time & Money with Online Permits and Inspections. Go To: www.buildingdepartment.com
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