IR - 750810
# 0018
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPEGTION REGIUEST
Job Address: ��-��r% ��-%�ti� �� ! Date: � �gr q/
Owner: � E ��''ll� � �Y.
L�a' I Lo1 No. I Block
Addition
S ��
p !
Plumbing Co.:� 1- S� �� �L `� "�' ��� `n� Master Lic. # �`%�
I agree to call for ins ions after uncovering the damaged line, before arry repairs
are made, and in when ai� is made but before recovering the line.
�-
Signature:
Water Line�
Fee: IS. p O
Total: �� QQ
INSPECTION FEE
Sewer Line ❑ Repair ❑ Relxation ❑
Fee: Per Chapter 206, Fridley City Code
Receipt # 0 5
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
�.�
Inspector: Date: ��a9/9/ //7�5�
White Copy—Inspection Dept. • Ye11ow Copy—Plumbing Co. • Hard Copy—Water Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner: � ,
Legal � No. Blcek nca�eo�
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 # �f . =�> �% ��
INSPECTION RESULT
Approved� Denied ❑ Comments
` �� � �l
Inspector. �' �� r Date:
White Copy—Inspection Dept. • Yell Copy—Plumbing Co. • Hard Copy—Water Dept.