P - 77678ORDER FOR PAYMENT NO. I
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Installer of Wiring � t! 4.S c i�. ��c.-T > C�
Owner/Occupant � h R 4. �4 ''y, Job ���+E _� K� L
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Property Address i �.
Date f � Yd °O � Permit No. �` ��-`�- °�1.3 � Date Filp'
O Additional rough-in inspection was required. � ; I
O No access - scheduled inspection. �
� shortage - see computation.
❑ Reinspection fee.
- £ �`
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OCT`;1J2 �C��'
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Fee Computation: °
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Please return this order wfth your check in the amount of /�`�— payable to the cfty/
township by (date) L' �2 .5 �-''�
Inspector � � �-I G� i''�`L Telephone ��- �� J- 7�S
RETURNTHIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERETHE JOB IS LOCATED. RC-02