IR - 75105� ��
� # �D42
CITY OF FRIDLEY
UTILITY LINE REPAIR/R�I,.00ATION INSPECTION REGIUEST
Job Address: �� /� �� r�� % ��`�"L— Date: �'"l� �
Owner:
Legal � �'1O• Broc,k/ nddi�on ,/�,
Description .�,� `7� A�2.f�!//f �[1 � / 1����
Plumbing Co�� -��e.�-- Master Lic. # �� �
I agree- all for in ions after uncovering the damaged line, before any repairs'
are made, a ain whe�rtkte repair is made but before recovering the line.
INSPECTION FEE
Water Line ❑ Sewer Line Repair,0� Relocation O
. ���'
Fee: Fee. Per Chapter 206, Fndley City Code
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Total: �� Receipt # l33/
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspeclion Dept. • 1Rellow Copy—Plumbing Co. • Hard Copy—Water Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal � No. Block Additron
Description
Plumbing Co.: Master Lic. #
1 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 D Relocation C
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved 't� Denied ❑ Comments
Inspector:� / Date: �/ /3�5�
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.