IR - 75109�' � � ��.o
# 0046
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address:���� ��� �.�'Z- ��- Date: '° �� ����
Owner: ��`.Z. �•�-`�.� —�w� �b�.s...S
e�oc� r° �aaroo�, � , �
Legal _� _ _ .
Ft�s ing Co.��� '���'z-ti-- Master Lic. #�.��'�
I agree to fter uncovering the damaged line, before any repairs
ar�made, an a air is made but before recovering the line.
INSPECTION FEE
Water Line ❑ Sewer Line'�. Repair t� Relocation ❑
Fee: �25.00 �: $25. 00 per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved ❑ Denied O Comments
Inspector: Date:
White Copy—Inapection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
�
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal LOT "° B'�k 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 ❑ Repair � Relocation ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt # �� �� C'
INSPECTION RESULT
Approved �� Denied � Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
` y� —��"' � 'Y`i ,�t/�Q/a./ �
/��,.�.�.�. ,�� �
�� �
�t,7�rc., ��f'�'�' U� ��� r