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P - 74967__ �, � :-;� � � �-� _:•�.s.� . _ .�3,� CITY OF� FRID�EY ✓ Nane: WATER /�ND SEWER CONNECTIOPI PERMIT APPLICATION Date• �� =' 19 `�`T' (F�loi+�e Owrnr or Piuer�r)� Job Address•--4a��t..� C.C.�1-�," F-rG-Li1,lU/�'� �„��j't'_'.L �' LEGAL DESCRIPTION � f-� I -/� I�i f-� .NLI /Ur.UM�it'.�nf-S PERMIT: ✓, r SEWER: _� WATER: '� METER: FEE: � } FEE: l�`�� DEP061T: z...►-�---� - O-DAPTER: 8TATE �'-'?j STATE � 8URCHARGE: ' �- �' SU�HARGE: � TOTAL: 7S S�� TOTAL: �� TOTAL: � GRAND TOTAL: �.r' °s� , CHARGE ON EXtSTING STRUCTURE: EXISTING STRUCTURE: NEW STRI�TURE: � BUILDING PERMIT No.: �� "°��U� SEWER/WATER PERMIT NQ.: � � 8rEC1AL ASSESSAAENTS_ �uur�=-- SiqrNd. �� _� . �,�1°� � "`�