P - 75600OR�ER FOR PAYMENT NO.
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Installer of Wirfng
Own@r/OccUpanta �'��'�''� �v� Job
,
Property Address �O� / � � `"e �jr-e1� °'� �p �j^S i�3 Z
Date �'r'� = 0� Permit No. �" Ot�Cflz-6 Date Filed ✓"� l3 - �'�
O AddtUonal rough-in inspeeHon wae required. ,
O No a�ess - scheduled fnspecdon.
�Fee shortage - see computatton.
❑ ReinspectlYon fee.
Fee Computatfon:
�
� CITY OF FRIDLEY
6431 UNIVERSITY AVE NE
FRIDLEY MN 55432
Please return this
townshtp by (date)
. '
_ .-
in th� amou►st of _ J'� P�_ aayable to the city/
Inspector JLl��-eG�'7` �i� v 1�v '' t Telephone C� S(- 7 7%%o 05�
RETURN THIS ORDER WITH PAYAAENTTO iHE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. RC_o�