P - 76399���� -C� C� i�C'D A PR - 5 200� -
ORDER FOR PAYMENT NO.
"z - �c� �- v� 6 6_� �SRDER � �AYIV�EI�T
Installer of Wiring C� Ctf N.c�
Owner/Occupant _ U9N �c� a(s Job .�j vc c�
Property Address �^� -5�^"" �T �T� k K ��• Zip �� c� i
Date �- 3�"' �'% Permit No. /^ S�v "'�� Date Filed y- L C- c.0
❑ Additionai rough-in inspection was required.
O No access - scheduled inspection.
�ee shortage - see computation.
❑ Reinspection fee.
Fee Computation:
�T
�v.�„i � � '3d e "v
�1 �� %
�
_�c� _ °.--
� �,��9
,� v -
Please return this order with y r in the amount of �� � payable to the cfty/
township by (date) �� �
Inspector ��.-��f�(. I�S o-�--� Telephone �7� %%7 %�r
r
RETURN THIS ORDER WITH PAYMENT TO THE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. RC-02