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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
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Job Address: �� d d � �' `��- Date: � � �
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Ow�@f: �=' v _ �''�� �
Legal � No. Blxk �� Addition
Description —/� / / f},Q��; /(� Q,��`{�.e.t� Q � '
Plumbing Co.� � �v"` � Master Lic #—�y;.:SL� A%
I agree to call for inspections after uncovering the damaged line, before arry repairs
are made, and again when the repair is m de b b�fore r overing the line.
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INSPECTION FEE
Water Line L'1 Sewer Line � Repair O Relocation �
Fee: ��� � � Fee: Per Chapter 206, Fridley Ciry Code
Total: l s• �� Receipt #� S�
INSPEGTION RESULT
Approved ❑ Denied � Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
# � .
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE(�UEST
Job Address: Date:
7r.�o aalt� � G�)
Owner:
Legal Lot No. Block Atldition
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:
Water Line � �
Fee:
Total: �� '
INSPECTION FEE
Sewer Line ❑ Repair C Relocation C
Fee: Per Chapter 206, Fridley City Code
Receipt # ` -
INSPECTION ESULT ,
Approved � Denied ❑ Comments
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Inspector. Date: � �_� �/ �
White Co y Inspection Dept. � Yellow Plumbing Co. • Hard Copy—Water Dept.