P - 75526ORbER FOR PAYMENT NO.
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Installer of Wtring �rG�-r^��.'y
wner cc�pant " ;�� � w t�/� fl-! V �� r.>d� ic �, Job � L°° te.,�eA� ►�:. �.�
Property Addres,s ��/� � t.t e_ I t� e� f.r �� �P
oate � -� �°� � �,�c No. =��5° � wF� oate Fi�a � �;-��'
O Add�ional rough-tn InspecNon was required.
O No access - scheduled tnspecdon.
� Fee shortage - see computatton.
� Reinspecdon fee.
Fee Computat(on:
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d � f � S°, $- =
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� CITY OF FRIDLEY
6431 UNIVERSITY AVE NE
F`RIDLEY MN 55432
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Please retum this order y r check
township by {date) � � -+
Inspector
� � ca
in the amount of � °
�,_,� aayable to the city/
Telephone � �� ]T 7-� �
RETURN THIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. RC-02