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P - 74934CITY OF FRIDLEY WATER AND SEWER CONNECTION PERMIT APPLICATION � .� � �� d � � Name: ivorway Pine Builders Inc Date: 6/15 19 92 (Home Owner or Plumber) Job Address: 1��2 iVortn uanUUe Hoaa �r� LOT NO. BLOCK TRACT OR AODITION LEGAL DESCRIPTION S 2 Innsbruck Nortn PERMIT X X SE WE R: WATE R: FEE: 25' �� FEE: 15.00 X METE R: DEP061T: °�'�� O•DAPTE R : STATE .�Q STATE ,50 SURCHARGE: SURCHARGE: TOTAL: `5' �� TOTAL: l�• �� TOTAL: v`�' �`� GRANDTOTAL: $lOL �0 S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: z12�8 SEWER�ATER PERMITNO.: ��'� SPECIALASSESSMENTS:� ��"�' Si� : aas Plumbir�g Inc � �y. � �,,%�-�-!�� -.i '� ,