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• Date of !nap.: de?:
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, 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