IR - 75126.� �
✓
# ��6�
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REQUEST
Job Address: � � `- ��� ' � Date: �� �� l �
Owner: N - � � �-� t-
legal �a ►ro. eixk �do�u«�
Description 'i.l� /% Z�y y ��7
( ( ,, ' 1
Plumbing Co.: �� �L-��f� �-��- Master Lic. fi�_ �' 1
I agree to call f r inspections after uncovering the damaged line, before any repairs
are made, anc�gain when the re�ir is Snade �b,ut before recovering the line.
" INSPECTION FEE
Water Line � Sewer Line C�' Repair C� Relocation ❑
Fee: Fee: %�UD Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTlON RESULT
Approved ❑ Denied O Comments
Inspector: Date:
Whhe Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy Wetar Dept.
r - .'
/
u 3 ._ ..
tt `�
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal �O1 "° B��k Addition
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 rJ Repair ❑ Relocation ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved� Denied ❑ Comments _��� S��li �iG -�1�(i U'�
. e
..1�0� .� n��.t � �.
Inspector: Date: /�— 6 ` ��
White Cop nspection Dept. • Y ow Copy—Plumbing Co. • Hard Copy—Water Dept.