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P - 75071
CITY OF FRIDLEY a WATER AND SEWER COPINECTION PERMIT - - APPUCATION -°, IHoms % ✓ Job Address: �°� L C.�:.:' LEGAL DESCRIPTION PERMIT Date: or Plumbsr) r`�i I(.. ; _ , , �' r�l,��.�, i OR ✓ �� �� 19 ��c"� SEYVER: --�~'"° WATER: �� METER:_� FEE: r� _'v FEE: ��� ����{-�`r DEPQSIT: +�:?,�� �j,� O-DAPTER: STATE �`,'; STATE <"'� SURCHARGE: � -" SURCHARGE: � '-� ������.,. —,.�� ,.r�� , � ,..� _ _�_ TOTAL: _� TOTAL: � *� � - TOTAL: �,�;_'`- ' � ��( L.. �� ., .. � GRAND TOTAL: CHARGE ON EXISTING STRUCTURE: �XISTING STRUCTURE: � � NEW STRUCTURE: BUIIDING PERMIT No.: �-�'' "� --�� �` SEWER/W E ERMI��N,p.: �a� � � � SPECIAL ASSESSMENTS:—`� �� `•�'�"°° �'�' ,������y� � Si�ed: ^� a� � .. �'� _ gy; ,��1 ,..l..r-�i �s� I� U _ '1....— O"