IR - 75091�
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# �028
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: �i l0 7� .� [� � J�Z �= Date:
Owner:�!- ,� if�D �'; l��Sr�,� •
Legal � No. Blxk naa�u«, �
Description /� / ��j G.F- � t ,=1 i �r _ �.��1s - S
Plumbing Co��4-�K.biE-flL '� /SotS �/ff �qiilaster Lic. #
I agree to cali f' ions after unc�vering the damaged line, before arry repairs
are ma , and again en the rep�irls made but before recovering the line.
.. �- o l l)
INSPECTIOW FEE
Water Line P�1 Sewer Line ❑ Repair,�, Relxation ❑
Fee: �� `~� Fee: Per Chapter 206, Fridley Ciry Code
Total: � � -'� �' Receipt # 3��'
INSPECTION RESULT
Approved � Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: �[� �5 f-�� Uf A1 �Q Date:
Owner:
Legal I� No. Block nadn�o�
Descri�tion
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 ❑ Relocation �
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved� Denied ❑ Comments
Jerr'y
Inspector. Date: �g"' ,��
White Copy—Inspection Dept. • Ilow Copy—Plumbing Co. • Hard Copy—Water Dept.