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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: �091 Hathaway Lane NE Date: 4���92
Owner: L �.vc�� L� �,
Legal `a "°. s'xk "°ai�°"
no�����r��., 42 2 Parkvietot Heights Addn.
Plumbing Co.: /�S �v %J19 Master Lic. #_ /� � (o
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, �rtij again when the repai ' m efore recovering the line.
/ �
INSPECTION FE�
Water Line ❑ Sewer Line � Repair L�3 Relocation �
Fee: Fee: 15 . 00 per Chapter 206, Fridley City Code
Total: 15. 00 Receipt #�� �
INSPECTION RESULT
Approved O Denied ❑ Comments
Inspector: Date:
WhHe Copy—Inspection Dept. • 1Rellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal LO' "° I e�«k Atldi6on
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 r
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #.
INSPECTION RESULT
. i�
Approved� Denied ❑ Comments
i.
y '
Inspector: ` Date: � � � � !
White Co Inspection Dept. • Y II py—Plumbing Co. • Hard Copy—Water Dept.