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P - 75037
Name: � CITY OF FRIDLEY WATER AND SEWER CONNECTION PERMIT APPLICATION i i L�c ivl� �rn i (Hom� Owr»�rp► Plumb�r) /�D ('�-��S � Date: : Y' :r5'-_'YyP_� � LEGALDESCRIPTION � /S � l -- IC_..f�lS- ( �f PERMIT: SENIER: �r WATER:� ME'TER: "'�_ FEE: FEE: DEP061T: O-DAPTER: STATE � SURCHARGE:�SURCH RGE:�� � TOTAL. TOTAL: �✓ TOTAL:.S -� GRAND TOTAL: ��O � UO 1� S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILOING PERMIT No.: ' SEWER/WATE PE IT O.: 9� 4J SPECIAL ASSESSMENTS: Sip�ed: �' - By: