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.f='14 rLC L'i ll..! !n liJ LMIT CITY PI'RMIT No <br />P.O.BOX 66 Date <br />^.YSTAL RAY. MINNESOTA 55323 <br />(612)473.7357 <br />%yJ�,;;��ed lfr Add... 14177 1��J1- &N& <br />•' 1 Address <br />! •:: -a No.— State License No <br />hND SPECIAL CONDITIONS <br />'; '*-U TYPE AND FEE: ❑ NEW <br />...:a Plumbing (g Rxtutcs_ ) <br />.Ivr!leter (Size_) <br />Meter / <br />Remote/ _ <br />Ilurieipal Plater Connection <br />❑Copper ❑ <br />Municipal Sever Connection <br />o P6'c ❑ cast <br />LM'CC SAC Ch✓'.c <br />/.C1-NC l7LL-!)LESdI:•NT <br />_ <br />❑ADDITION <br />❑REPAIR <br />Fee <br />S <br />On Site Septic System <br />Fee <br />S _� <br />Fee <br />S <br />Water Well <br />Fce <br />S <br />Mechanical Equipment <br />Fee <br />S_—__ <br />Fee <br />S <br />Moving/Lifting Buildings <br />Fee <br />S _ _ <br />Land Alteration (Excavation. <br />Fee <br />S _ <br />Grading, Filling. eta) <br />Fec <br />S <br />Othar'___._ <br />Fee <br />S <br />i ;- <br />fee <br />Ste_" <br />After -the -tact Investigation <br />Fee <br />S <br />ru uner_-•d he"".t'na.L•de:. rtt<Ipt.Ittb L'hwd <br />F.".a C5p a«p L.t. a {a I" 0:nn. <tleq <br />ev.. <meltlew . nee=..0 Nt.. .h... n. <br />l. .,^..( 1 —.d u.den� u eld .`d. wet" er U. • i. p<mW b t141b qM.d In c.'. 1. eu .mp. <br />adder he lhe.- nrhl gwe'd; M.1 Cb {Ymb dw <br />.. pent or ..0adb 1. e. vet he wetleu .ecu_e <br />.pv.. Lmb .1 .' .: and Lt.t Itu ptt�ll em e.l <br />Oml .uq.db W <W.. C' le"U1. .1 .) Cb <br />.glum- .1 S.. M., rul. < teCW.L'm. An .ai L%ex U <br />dew N .W<t <.mr9.n<. 1ld .a Cie,ehnh..<.. turehe <br />.ew. mdl- h1tl0 l:p4enul <.,etev.... 4 ata w <br />L Ael I. M.p.<d.n, M:.'d . 1qu Cen n) 0. per. <br />au.new. .e .gaud, n. md.wdn.d A . a se e.el <br />l...A Y y b <l.Ldm el <br />W. p.lmll <br />Slzp d tmT pplicant <br />d <br />T 'eAL <br />Sidle Surchatge: Fee S i <br />Total Amount Paid toCity Fee f <br />I <br />This permit is not valid until the proper fee is paid dnd <br />it is approved by an authorized City Official. <br />Signature of City Official <br />- f.d< w7we fa.Copy fins le�d[Iwt Cup< L line IM... C.yr INd A"kast'l a..npt <br />