P - 75595ORDER FOR PAYMENT NO.
� ���� <j p� �� � �
�Installer of Wiring
Owner/Occupant �'�C( R- �i :"5'E�°�/'+� Job �°�/ �" ''�
Property Address l c� � o��.c��Cy ��K ./� aP � L
Date �'/�^ —� Permit No. � oa$ tl 6 6�' 3 Date Fled j�'" �"��
O AddtUonal rough-in inspectton was required.
O No access - scheduled inspectlon.
�ee shortage - see computation.
O Reinspectlon fee.
Fee Computatlon:
�
u
n�/ d,��'
� S ��
�
�c 2 = t� S�. � .
K�
A
I
�
� CITY OF FRIDLEY
6431 UNIVERSITY AVE NE
FRIDLEY MN 55432
- �, f�
� �
Please retum this order�� yaur chedc [n the amount of �/• � uayable to the cfty/
township by (date) --
Inspector � Cc s Telephone [�,���' 7%% ��-�
RETURN THIS ORDER WITH PAYMENT TO THE CITY/TOWNSHIP WHERE THE JOF� iS LOCATED. ar._n�