IR - 75139�
# ����
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: 5201 - 3rd Street N. E. Date: Aug. 31, 1989
Owner: Helen Bigos
L8g81 �.a Mo. s�ock Addrtion
no��.�.,r��� 6 1 Carlson's Summit Manor A dn.
Plumbing Co.: �'�olz Company Master Lic. # 3233M7
I agree to call for inspections after uncrnrering the damaged line, before any repairs
are made, an�agai� when the repair is made but before recovering the line.
INSPECTION FEE
Water Line L� Sewer Line ❑ Repair O Relocation ❑
Fee: 15. 00 �; Per Chapter 206, Fridley City Code
Total: 15. 00 Receipt #�33 7d %
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
Whi1e Copy—Inspection Dept. • Vellow Copy—Plumbing Co. • Hard Copy Water Dept.
0
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal Lot No. Block AddiGOn
Plumbing Co.: Master Lic. #
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, and again when the repair is made but before recovering the line.
Signature:
INSPECTION FEE
��
� Water Line �; Sewer Line O Repair ❑ Relocation ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt # ---=—' �?p/
INSPECTION RESULT
Approved !� Denied ❑ Comments
tnspector• Date: �"�� ���
White Copy—Inspection Dept. Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
l�'f�_ /%j��/T� /1���� f� J�%��ET /�l� c°fs� o�e�/rl�i .