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# 0032 '
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REG1U ST
Job Address: � 7 � � � A � � � �� Date: y �
r
Owner. �,�1 /� P_ �-/ / i � C �%�
Leg81 �a No. e�ock �aattio�
Plumbing Co.: i Master Lic. #—��
I agree to cail inspection `after uncovering the damaged line, before any repairs
are made, and �ain when the repair is made but t�qf�e recovering the line.
� " INSPECTION FEE
Water Line � Sewer Line �' Repair �, _ Relocation�
Fee: � � 1% Fee: Per Chapter 206, Fridley Ciry Code
Total: Receipt # ��%'�
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
i /
�
, #
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: Date:
Owner:
Legal �rn No. e�«k ndd�uo�
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 ❑ Repair ❑ Relocation�
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved � Denied O Comments
Inspecto � c�� Date:J���Z—
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.