2005-01919SEP -08-2805 12=20 CITY OF FRIDLEY
Date:
Job Ad9s:
Mammo of APF
Noone of Frog,
city ot'rridley
6431 University Ave NE
]Fridley UN 55432
(763) 572,3602 or Fax (763) 542-4977
Water and Sewer ]Permit APP11CatiOn
ew Connection
C] Existing
P.02/02
Utility Lune RepaWRelocadon
ate and Sewer Connection
Exisft SbvcWe Permit #
permit Type: Sewer Fee:
Water Fee; — ,.,
Meter Fee:
Ftepalr Fco:
Relocation:
Sate Sureharge=�
SAC Charge:
Spmial Awipwsment Fee: —
Inspector approval: _
Nj(W(15
TOTFL P.02
TA R. VA H 'R RNTSiWfT-L4 AIN -49T-1 RRF,T.9/RF9/ 00:7.T RAA7/RA/RA