P - 76134ORDER FOR PAYMENT NO.
�� - ' �G� v77 67 � ER � �aY1�19T
Installer of Wiring �� ej
Owner/Occupant ��r/� �•4 Job �a� `
Property Address ����D � �9 � �"✓4P+t �ye �R! �O! �P �
Date �].r � �— 4� Permit No.
rough-in lnspection was required.
❑ No access - scheduled inspection.
❑ Fee shortage - see computat(on.
O Reinspecdon fea.
Fee Computation:
Da4e Flled �s° � 3°' ��
��,�p � �1� I
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� CITY OF FRIDLEY
6431 UNIVERSITY AVE NE
FRIDLEY MN 55432
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, � �: 0:�.�
Please retum this order ith you chedc in the amoun4 of �� ' payable to the city/
township by (date)' �D " �
Inspector `� �` C ��r�� Telephone _��� %%%� ��
RETURNTHIS ORDER WITH PAYMENTYOTHE CIT1fROWNShIIP WHEFiETHE JOB IS LOCATED. RC-02