IR - 751170
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# 0054
CITY OF FRIDLEY
UTILITY LINE REPAIR/R LOCATION INSPECTION REGIUEST
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Job Address: `� a��� � L =� � � ��,'� t Date: �' ' � � ; r_.
Owner. �; �'��`� � � ��r , %� Gti- �'� � '� �`
Legal � No. Block �aa+u«,
Description � �L- �Q.S� �
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Plumbing Co.:• "� � � ��'� ��� Master Lic. # � � ���
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, and again when the rep�ir,is made but before recovering the line.
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Signature: �. !. C� e---Z �' ,.� � �- =
INSPECTION FEE
Water Line,e� Sewer Line O Repair,� Relocation O
Fee: �•�O Fee: Per Chapter 206, Fridley Ciry Code
Total: • U Receipt #
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspeclion Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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0
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal �rn No. eio�k noa�i�o�
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 O Repair ❑ Relocation ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #_�',- . _.
INSPECTION RESULT
Approved '—' Denied ❑ Comments
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Inspector. Date: ' � �
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.