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P - 76192ORDER FOR PAYMENT NO. _ _ � �� -- � 2—/� � � ��R �� Installer of Wi�ing , �! �� `l'Y� "` � �� Owner/Occupant v� �h°C°� Job ��i( %l �� Property Address � �.� �7 " �6 �-� `� " Zip %�'� Date i6 ° Z�-^ °� Permk No. %��' �� Date Filed ��R '"-� ❑ Additional rough-in inspection was required. O No access - scheduled fnspection. ee shortage - see computation. ❑ Reinspecrion fee. Fee Computation: � t1e� � �tr,��, l ( d, � �;�, �o� �- . �� s� � °�- �� a � DT Lti1..,�1 ��'. � ``+� �� CITY OF FRIDLEY 6431 UNIVERSTTY AVE NE F�I,Ey MN 55432 � �" c� Please return this order ith your check in the amount of G�° payable to the city/ township by (date) �� "] °- 06 Inspector ��D.t-'.�r—"�� Telephone �a�y ��% � �� RETURN THIS ORDER WITH PAYMENTTO THE CITY/TOWNSHIP WHEFiE THE JOB IS LOCATED. RC-02