P - 76532ORDER FOR PAYMENT NO.
2 � ��os v� 9 a �
ORDER FOR PAYMENT
Installer of Wiring .�'f1S o'�n �� 1'enS �i
�wnQNbccupant ii _ Job �-�f �1 c c..c._
PropertyAddress -1�P��V" '` /��/R-!�! �l �(�-. Zip�
Date
Permit No. � "'a��—'t�� Date Filed
❑ Additional rough-in inspection was required.
O No access - scheduled inspection.
0 Fee shortage - see computation.
L�'Reinspection fee.
Fee Computation:
i
- i�1 � � � �Er6,G
�J�^ 06
Please retum this order with yp tgck in the amount of d` V` payable to the cky/
township by (date) �
Inspector / �a � � ` �/� Cc S 6��� Telephone (O �� / JT / ��
RETURN THIS ORDER WITH PAYMENTTO THE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. RC-02