P - 77760ORDER FOR PAYMENT NO.
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Installer of Wiring �`JnS.S i %�-5 £��
Owner/Occupant_ '� /�/ �� c�� 4 l� n v a Job �� ��"��'—
PropertyAddress 0 U�'�`'— /'�'�S�i ��^'�+ Zip ��S �` 3�
Date /�.��'C� Permft No. J�� ��f" Date Filed //- ��s"E
O Additional rough-in inspection was required.
❑ No access - scheduled inspection.
Fee shortage - see computation.
❑ Reinspection fee.
Fee Computation:
/�'� � � �_a.e_ $ S
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Please return this ord ith your chedc in amount of ' /°" ayable to the city/
township by (date) _ � / �- — oS
Inspector ��� e� a Telephone lp� �' 77 T%&'��
RETURNTHIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERETHE JOB IS LOCATED. RC-02