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P - 77675ORDER FOR PAYMENT NO. `� �� 5' z. -. � c�-�s- -- � �.3�. 3 �F��- T installer of Wiring `%L i--� �'� 2 C%-a.�-� _ �c _. Owner/Occupant �� `` �'` s°``� Job c�A ��--�-- Property Address ��5� C��t`' S• �-€ lZ� 14� Zip S� ��i Z Date �' �'' `� Permft No. � 1�� °�"' 3 y� Date Filed � Additional rough-in inspection was required. O No access - scheduled inspection. �Fee shortage - see computation. �O Reinspection fee. Fee Computation: � � I�'�'�� Js?—� L� �._ c ) �' �� ''1 z �"�: s%-� a� ��E f�r> _ 5 '—. ` �" � ��, �,c= �'i4�Ly � C�*�i � l " C�a;,�, J Q�cs� �i {�"� N•£" `�� r � lti� /�y / ,�. _ �' � �F ,3 ,r�.- �c Please return this order ith your check in the amount of ,�� payable to the city/ township by (date) �I i� " �'; � Inspector �� t-'• Telephone �� 5/— % 77--T N3S RETURNTHIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERETHE JOB IS LOCATED. RC-02