P - 76879ORDER FOR PAYMENT NO.
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Installer of Wiring �I.� c�/Z r c� (... (/ / S t o�cCS .�,vC—
Owner/Occupant `�' /�,i„i.�, d� �.._
Job
Properry Address �� rv/ � a0-u�l- /�� Zip �-�-��
Date �a '� a2s �j�-E % Permit No. �d � i G! $Z� Date Filed � :�'�4 %
D Additional rough-in inspection was required.
❑ No access - scheduled inspection. ^� ��
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�ee shortage - see computation. �� � r � /
O Reinspection fee. � Q Z007'
Fee Computation:
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� CITY OF FRIDLEY
6431 UNIVERSITY AVE NE
FRIDLEY MN 55432
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Please return this order with your check in the amount of -5 (p. ' �ayable to the cityl
township by (date) 1�/�- j� r - 0 7
Inspector_- �.�o�'�'-���.�1 f p�,•`� Telephone �J�`7%�%�-%��.�
RETURN THIS ORDER WITH PAYMENTTO THE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. � RC-02