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# 0�66
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
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Job Address: -'� C��C Q� �-� Date: �'�'
Owner: — / fi ti-�/� �- �-� �
Legal �a r�w. eixk /+� ndd'n�o� �^�
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Plumbing Co.: 1�� �l.I GN�1 / Ll'�r�/N� Master Lic. # �f �f� Z
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.
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Signature:�.AC�a-�� �c 2 Z rh �
INSPECTION FEE
Water Line D Sewer Line � Repair L� Relocation �
Fee: Fee: �S �� Per Chapter 206, Fridley City Code
Total: Receipt #�!a3 �
INSPECTION RESULT
Approved D 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: ��x%cn (`7l ��LT%�U �� Date:
Owner:
Legal � No. Block naa���o�
Description
Plumbing Co.: /"! ��'�l�l�l ��.LL iylvJ/�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: %�/%L1f7�F_ �D/hH5
INSPECTION FEE
Water Line C Sewer Line O Repair ❑ Relocation C
Fee: Fee: �� Per Chapter 206, Fridley City Code
Total: Receipt #-��-'=�
INSPECTION RESULT
Approved �Denied ❑ Comments
Inspector. � Date:��!�
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.