P - 76052ORDER FOR PAYMENT NO.
�� �-c�a6�-c�/o3y� Z�R—DER ��
Installer of Wiring �����1
OwneNO�upant�� ��e Si'.r�� Job ��
Property Address ��/ '' �A'C�, � �p � �.�!�
Date PermR No. �"'° �f �' ��� Date Filed
O Additional rough-in inspectton was required.
O No access - scheduled inspection.
�fee shortage - see computation.
�Reinspection fee.
Fee Computation:
�c- z'�r..�� �- ? �' � s `% ,�.
c.�'c.
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2�
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Please re,iUrn this order ��r c�11n th� amount of ��` �ayable to the city/
townshtp "by (date)
Inspector _ ��� ��, Telephone �V/ "77 '''a �
RETURN THIS ORDER WITH PAYMENTTO THE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. RC-02