HomeMy WebLinkAboutFee Shortage Order Form - ER22-000112 ORDER FOR PAYMENT NO.
4!�2-, vooL�-1 ODDER FOR PAYMENT
Installer of Wiring t iy,C t �l/i tf G
Owner/Occupant Sze u j Cl Q2 Job. &j2 Jet cc ,-1
Property Address ,, Zips
Date 7- J`Z-2- Permit No.r`l(-2d ovV 1 - Date Filed
❑ Additional rough-in Inspection was required.
❑ No access-scheduled Inspection. CITY OF FRIDLEY
Fee shortage-see computation. IIB■� 7071 UNIVERSITY AVE NE
- ti a1voF
O Reinspectlon fee FMDLF' FRIDLEY NIN 55432
Fee CompuWam,
,
le �a s
�z
Please return this order with your cheek in the amount of � payable to ttte it/
township by(date) a-2-
Inspector e24142 :f-j C/-A-f�,S , Telephone 6 5T 777-
RETURN THIS ORDER WITH PAYMENTTO THE CITYnVAMHIP WHERE THE JOB IS LOCATED. RGo2