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P - 74971. .,, . :. b.. .. ;,. -„':wa, ' .:;.... ; _ �..,: � `� ` , �.x-•. � .;c � : a.�:�r �i'a+ur..s ... svs . -- �..ti,: , . �.. - � . . . . , - , � � CITY Of FRIDLEY � WATER AND SEWER CONNECTION PERMIT �� € APPLICATION � , � f � ��, e�iestlin� C�ns�ructior_ De�, lU/12 19 94 F • (HonM Owrnr o► Plumb�r) 4 ��. �42U, 5422, 5424 & 5426 4tii 5ti�et 1�F: LOT NO. BLOCK TRACT OR AODITION LEGAL DESCRIPTION f;-13 1� �ami.lton' e Addr to r"_ech. '. PERMIT: ' SEYMER: �' WATER: X METER: FEE: �� • U�� FEE: 15 • ��' DEP061T: O-DAPTER: STATE 5� STATE .SG ` SURCMAR(iE: �_ SURCHARGE: i TOTAL: �5'S� TOTAI: 15.5U TOTAL: GRAND TOTAL: �4 Z ' �" �' SA.C. CHARGE ON EXISTING STRUCTURE: F EXISTING STRUCTURE: NEW STRUCTURE: �i �, BUILDING PERMIT No.: 2�y03 SEWER/WATER PE IT NO.: �`� � BPEqAL A6SESSIYIENTS• $ ��L