P - 77586ORDER FOR PAYMENT NO.
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Installer of Wiring %� Z? A- �-F �. ���-�°�
Owner/Occupant S 7-� � /�c"� ��1 ` � �-�.-� � • Job �4'��I � -� zf• � F
Property Address
Date
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Permit No. /^��'� " S7 /� Date Filed
O Additi�al rough-in inspection was required.
0 No access - scheduled inspection.
C�F`ee shortage - see computation.
O Reinspection fee.
Fee Computation:
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Please retum this order w' h your chedc i� amount of l•�� F' payable to the city/
township by (date) � �--�t �- o- S
Inspector �--�'� �� �-'Q–�� Telephone � � � ���'� g��
RETURN THIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERE THE JOB IS LOCATED. RC-02