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P - 75054
�ti. C Q r,�-: w.. ,. �-. ._.,, „ :'. r . . , ,. .. :'. . - - - - M, � t> y„��� �x � w.a . ' n , , 7 ,?�, < ��I _.._—�- .. �i� � TY OF FRIDL�Y WATER AND`SEWER CONNECTION PERMI APPLICATION (Harr OhrMr or Plumll�r) iyy �-��,�s.� �,� � LEGJp�,��;#t IpTION � PERMIT: : ' SEWER: �_ FEE: °� `� �v. 0 ,/��'�r i Date: ��G 19�— c� � WATER:T_ METER: � _ FEE: �' pEP061T: �/✓ O-DAPTER: �� STATE � SURCHARGE:- �� g�J�HA GE: S6 TOTAI s� •�� TOTAL: �S' � TOTAL: ��� GRAND TOTAL: /�/ � S.A.C. CHARGE ON EXISTING S'7'RUCTURE: EXIS{ING STRUCTURE: NEW STRUCTURE: .� BUILDIMG PERMIT No.: SEWER/W TER P �ECIAL ASSESSIIAENTS: 5��� ,� Bv� _