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# �- 047
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: �'s - �� `��i �"� Date: /� ✓� S
Owner: � �Gl- �S ��cl�.E�_ ----
Legal '�a "°. e'°�k ^°°�u°"
Description /(p �/t /J (y�-
Plu Co.: `��C — ��»�'z-�- Master Lic. #5=��
I agree to � in ' ns after uncovering the damaged line, before any repairs
are ma�e, an whe e repair is made but before recovering the line.
Signature: �=--- ��> >`�� �
INSPECTION FEE
Water Line ❑ Sewer Line L9' Repair O Relxation O
Fee: $ 25 . 00 �; 25 . 00 Per Chapter 206, Fridley Ciry Code
Total: o�s � Receipt # ��
INSPECTION RESULT
Approved � Denied ❑ Comments �aQil /t�a.c�, �
_•t�- �, .Q %� - �,2 ..,, o �
Inspector: Date: �d ' .; " /. '��
White Copy nspection Dept. • Copy—Plumbing Co. • Hard Copy—Wate► Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: Date:
Owner:
Legai �� "O e�ak Addition
Description
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 � Repair � Relocation r
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt # i
INSPECTION RESULT
Approved � Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.