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4676 Traverse Pt 14W ;Eder b Wrmlt `FH. t ,s __ lAseeetstaigiir M isc. Cha rges; 6t' . f3 1 per t � • B F- 'Moto R • Date of !nap.: de?: Cyr ttioAti - leatfitt A , irw 1411. Rea Reed PERMIT NCk ' lave, MN '1122 DATE: i J : Zo fling: No. of Units: 1> 1,71-T 4 �. owner; Address: Site Add ress : 4 C tfi " .. ' i 1 ? pie:- 1c 1 . r f t . 4 t P1Imnber n " ~ t r 1 01 ' J . , 7 167 ,. I agree te sew* wRh the City of lieges Connection - Charge: 47 ' , - c' • Account Deposit:- Permit Fee: / 10 47 ' r Su iarge: pt- $Y Misc. Charges: Date -life. Total: Insp. / `> L Date Pole