IR - 75093# 0031
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address:
y% �f S% t��i-�2 Date: Il—�3—`r�
Owner: � ��
Legal �°` "°. a'°`k n°°'''°"
Plumbing Co.: �� ��"'�`''"� Master Lic. # �y' �
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, an the repair is made but before recovering the line.
Signature: —
INSPECTION FEE
Water Line I� Sewer Line � Repair ❑ Relocation ❑
Fee: �3� �D Fee: Per Chapter 206, Fridley Ciry Code
Total: Receipt # J���
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White CopY—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RE�OCATION INSPECTION RE(IUEST
Job Address: Date:
Owner:
Legal �� No. Block Addition
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 # ' '
INSPECTION RESULT
Approved� Denied ^' Comments
Inspector Date: �/ � l 3� 7�
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.