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P - 75063
Nsrne: C1TY OF FRIDLEY ; WATER AND,SEWER�CONNECTION PERMIT APPUCATI ON (Hom� � �.Y LE6AL, �ESCRIPTION PERMIT: Date: � �v 19� r / /\J � /. r SEYVER: FEE: �SUU WATER: �� FEE:� METER: �" DEP061T: �. �IU 0-DAPTER: STATE Sv 8TATE SU SURCMARGE: SURCHARGE: TOTAL: °CJ ' w TOTAL: ��5� TOTAI: � O, � �� GRAND TOTAL: �j�� � S.A.C. CHARGE ON EXISTING STRUCTURE: . ' EXISTING STRUCTURE: NEW STRUCTURE: �"'� BUILOING PERMIT No.: S�� $EWER TERAE MIT :� 8PECIAL ASSESSOAENTS: SiprNd: %'� ey: