IR - 75131�-
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CITY C1F FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: / � �� /`t�.��^�� ��,` D�te: � �� ��C1
Owner: �Citit,�
Plumbing Co.:
Master Lic. #�
I agree to call for inspections after uncovering t damaged line, before any repairs
are made, and again when the repair is but before recovering the line.
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Signature: ,
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INSPECTION FEE
Water Line � Sewer Line l� Repair � Relocation E�
Fee: l S�' Fee: ls'�'� Per Chapter 206, Fridley Ciry Code
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Total: �� Receipt # 4/9�/
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector.
White Copy—Inspection Dept. • Yelbw Copy—Plumbing Co. • Hard Copy—Water Dept.