IR - 75125:/
# �062
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: ���SS �,��' °`� Date: � � �
� _ i , _
Owner:
after uncovering the damaged line, before any repairs
the repair is made but before recovering the line.
INSPECTION FEE
Water Line ❑ Sewer Line � Repair �� Relocation ❑
Fee: Fee: �� � Per Chapter 206, Fridley City Code
Total: Receipt # � ��
INSPECTION RESULT
Approved O Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
#-
CITY OF FRIDLEY
UTILITY LINE REPAIR/R LOCATION INSPECTION REGIUEST
Job Addr ss: ��S r i�-T/�WC- � (O �O
e Date: �
Owner:
Legal Lot No. Block
Description � g
dition �
��
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 r
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT . ��
Approved � Denied �' Comments '�� �� �r �'�� � ���` ^ ��
��°��C�'i
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.