IR - 75103.
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# 004� '
CITY OF FRIDLEY
UTILITY LIN� REPAIR/RELOCATION INSPECTION REQUEST
Job Addre��'7_"1, � �� , � � Date: � f � " ��
Owner: ', `^ !�' \ '� � _ �' , �
Le al � No. Block nod�
9
Description �_ l �-��� �-� y /� 1�-���-)C t.
Plumbing Co � � � � `� � I t, y'�� �.' �� Master Lic. fi� � � ��^
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I agree to call for inspections after y�ncovering �F1e damaged line, before any repairs
are made, and again when the�pair is, g�but be�re recovering the line.
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Signature:�,,,—�_ , , , ��_. , � ? � :;
�— =� ��
INSPECTION FEE �
Water Line 0� Sewer Line O Repair CC� Relocation ❑
Fee: �' Fee: Per Chapter 206, Fridley Ciry Code
Tota�: �� CG Receipt # I��9
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspeclion Dept. • Ysllow Copy—Plumbing Co. • Hard Copy—Water Dept.
1 .
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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal �Ot "� eixk naa���o�
Descri�tion
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:
Water Line ❑
Fee:
Total:
Approve
I
Inspector:
1
White CoPY-
INSPECTION FEE
Sewer Line O Repair � Relocation �
Fee: Per Chapter 206, Fridley City Code
Receipt #
INS9�CTION RESULT
ied ❑
Copy—Plumbing Co. • Hard Copy—Water Dept.