IR - 75118UTILITY LI
Job Adi
Owner:
Legal
,/
# oos�
CITY OF FRIDLEY
REPAIR/R OCATION INSPECTION RE�UEST
�� S l iZ,C? L U 2� Date: %(�1���
)[J/1/)�tJ �ULilfIL�N '
Lot No. Block
6 �
Addkion
C�J
Plumbing Co.� V"� M ter Lic. #���Z
I agree to call for inspections after uncovering the dam" ag ie�dTrie, 6'� any repairs
are made, and �in when the�paj i� made,tsUt before recovering the line.
INSPECTION FEE
Water Line ❑ Sewer Line C9' Repair [�' Relocation �
Fee: Fee: Per Chapter 206, Fridley City Code
Total: �� � � Receipt #1�52_L_
INSPECTION RESULT
Approved ❑ Denied O Comments
Inspector: Date:
Whke Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.