IR - 75114�,:
# 0051
CITY OF FRIDLEY
UTILITY LINE REPAIR/R OCATION INSPECTION REG1UESy �
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J�� Ad�ress�
Owner. �- � �( �� � �
Legal � No. Block
Description �a �
Plumbing Co.: '
I agree to call f inspecti s after uncrn
are made, ancj,qgain when the repair
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Master Lic. #���5 Z
the damaged line, before any repairs
de but before recoverina the line.
INSPECTION FEE
Water Line L9' Sewer Line O Repair ❑ Relocation ❑
Fee: �� �� Fee: Per Chapter 206, Fridley City Code
Total: s` � Receipt # � 3� �
INSPECTION RESULT
Approved � Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.