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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
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Job Address: ��� L= �`.L�tl�'l. `d!• Date: � C- 0�
Owner: �'��i�1 f/ /��IZ(',�'���[023 � -- _- -_--
Legal � No. 81ock �aam«�
Description �i'. ,� / �� p�t,� �S; �
Plumbing Co.: � (� • Master Lic. #�
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, a gain when the pair is made but before recovering the line.
Signature: � � � �Q����
INSPECTION FEE
Water Line J� Sewer Line ❑ Repair J� Relocation ❑
Fee: ��'• � 0 Fee: Per Chapter 206, Fridley City Code
Total: /S. � � Receipt #
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address:
Owner:
Date:
Legal LM No. Block 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 rJ Repair ❑ Relocation ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total
Approved � Denied �
Receipt #.
INSPECTION RESULT
Comments
Inspector:Q�, Date: ����_
White Copy—Inspection Dept. • Y Ilow Copy—Plumbing Co. • Hard Copy—Water Dept.