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# 0033
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: � 7 D/ �� t��--c.vao� ,D2 oate: »-�� - g�
Owner: � �` ��� �
� �a nw. eack naa�uo�
De cription �`� / �jDo2�. [.�fi�� �,�jL�V �S �—
Plumbing Co.: i �r- - i� �. �f Master Lic. #��� �°
�... ,� k..a"..
I agree to call for inspections after u c�verin e�a aged line, before any repair5
are made, an in when the repair is ade b recovering the line.
Signature: �
�`
INSPECTION FEE
Water Line ❑ Sewer Line � Repair � Relocation ❑
Fee: Fee: � S�U Per Chapter 206, Fridley City Code
Total: Receipt # ���1
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Veliow Copy—Plumbing Co. • Hard Copy VVaMr Dept.
�
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address:�_����/ � C-�-%f.t�f�C1D � �2,Date: l�-��' %
Owner:
Legal I �rn Na. I si«k I naamo�
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 L; Sewer Line'� Repair� Retocation !=1
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt # � 3 -
INSPECTION RESULT
Approved' ` Denied ^ Comments
0
Inspector: � Date: /� " �7 — �(�
White Cop nspection Dept. • II py—Plumbing Co. • Hard Copy—Water Dept.