IR - 75115f
,
# 0052
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
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Job Address: � Date: S� Z S�.
Owner:
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Legal � No. 9bc�c nddidon
Description -,3 ,�0 .L?!�' �-t S (/¢-�� Lr;� `
Plumbing Co.: Master Lic. # ����
I agree to cali for inspections aft� o�ering the damaged line, before any repairs
are made, and a ain en e if is made but before recovering the line.
Signature.
INSPECTION FEE
Water Line C9` Sewer Line � Repair�-- Relocation O
Fee: �S -��� Fee: Per Chapter 206, Fridley Ciry Code
Total: � � - �?�� c� T �
Receipt #
INSPECTION RESULT
Approved � Denied O Comments
Inspector: Date:
White Copy—Inspection Dept. • Yetbw Copy—Plumbing Co. • Hard Copy—Water Dept.