IR - 75113, N��G � � ����- .
. �� 3 I -�
`� �� Y� # 0050
� CITY OF FRIDLEY
UTILITY LINE REPAIR/RELO TION INSPECTION REGIUEST
Job r .� f �-7(.»��{ � '7 'a�� ' ��
Adr ess: _ �ate:
�
Owner: � �S%! ��-
Legal I `.a "°. � I e'�
Description �j�
naa+t�o�
.� i
, /y� „�
Plumbing Co.: ��� �`i' ,/��� G� Master Lic."# !��
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, and �in when th� repair is rpade but before recovering the line.
Water Line �
Fee: l� • � C1
TotaL• ���� �
INSPECTION FEE
Sewer Line ❑ Repair Q' Relocation ❑
Fee: Per Chapter 206, Fridiey City Code
Receipt # / -J 3�
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector:
Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.