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# 0056
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: �' �-�% / !� } / !� f� � �L��- Date: �� � ��c'-
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Owner: `.
Legai �O'
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saok �aan�, ,vl�
Au � . �� . �.�� ��,�
Plumbing Co.: (_ rN i K.�L 1'L.bCo �,v Master Lic. #
I agree to cali for inspections after uncovering the damaged line, before arry repairs
are made, and a ain when the rep ir is made but before recovering the line.
Signature: � �% �- � �-t"A L.� � f 1�
INSPECTION FEE
Water Line ❑ Sewer Line l3 Repair ❑ Relocation ❑
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Fee: Fee: � S- G� Per Chapter 206, Fridley City Code
TotaL• I� ' �� Receipt #
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Ye11ow Copy—Plumbing Co. • Hard Copy—Water Dept.
$ ��'�s iz -rb -9� G�
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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal � No. Blotk Addifion
Description
Piumbing 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 rJ ' Repair ❑ Relocation �
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved 'j� Denied ❑ Comments R��1���� 3 � f o F �!K U(dHNyf �E �
o m
Pc P� wt�/�I �E �" �vc' (��G �
Inspector: � Date:� � � /�' � '�
White Copy�lnspection Dept. • Ye ow Copy—Plumbing Co. • Hard Copy—Water Dept.