P - 76050ORDER FOR PAYMENT NO. �� ���� P�
°Z- � �e� �.. oa��� ��R �
Installe�eof 1Niring `� G S �fRR� � �ee.l� � •
Owner/Occupant � f i,e � S •�%��,/i'.�%� '� s �-l9TI Job
Property Address � � o l �o �t ( � � �1 • Ztp �!� �
Date �/ �/� • o r Permit No. /� ��a °��9 D�se Fied �-3--� 6
❑ AddiUonal rough-in inspection wes required.
O No access - scheduled inspectton.
I� Fee shortage - see computation.
❑ Reinspection fee.
Fee Computatfon:
/�7�� �° �a.� �%•?<•GGt�.S - �go co
Ccyr���"'y ��
%•c�
��
�. �
/�� � �°° 6�=
'�-- ei.
- _/�2 f e2�.� ,i`o 0
�
�
� CITY OF FRIDLEY
6431 UNIVERSITY AVE NE
FRIDLEY MN 55432
Please return this order with ur chedc in the amount of �D� °�
aayable to the city/
townshtp by (date) �— - B�
Inspector_ �����^��� Telephone �.5�7%%����
RETURNTHIS ORDER H/ITH PAYMENTTOTHE CIT1(/TOWNSHIP WHERETHE J0� IS LQCATED. RC-02