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# 0034 �
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
JobAddress: 6551 Channel Road NE Date: 1/21/93
Owner: S& R ManaQement - �% C-c�-'%� f�f�%
Legal � No. Block 1 AddiGon
Description 9 1 Erco s lst Addition
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� Plumbing Co.� aster Lic. #;3Z�
I agree to call for ins i s after ' g t ama line, before arry repairs
are made, and ag en t re ' is e b efore recovering the line.
Signature:
INSPECTION FEE
Water Line ❑ Sewer Line � Repair (�i Relxation ❑
�; F�: 15. 00 Per Chapter 206, Fridley City Code
Total: 15. 00 Receipt #
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspeclion Dept. • Yelbw Copy—Plumbing Co. • Hard Copy—Water Dept.
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GITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal �' "° s��k Addition
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 #.
INSPECTION RESULT
Approved� Denied O Comments
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Inspector: s,P�T,e: ` I-� l—,lc 3
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.