IR - 75089�/
# �ozs
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: ���i� � cS ! SL� � Date: � ' � � � g�
Owner. �J � c s- � �c-/ Kf ..�
Legal � No. Block Addition '
Description � � / L,, �f} j� (-0,Q.S
Plumbing Co.: �� ''� � t` Master Lic. #�� ���
I agree to call for inspecti �(ter unc ring the damaged line, before any repairs
are made, and a�n en �ie repair is made but before recovering the line.
Signature:
INSPECTION FEE
Water Line LK Sewer Line ❑ Repair C� Relocation �
Fee: ��� �p Fee: Per Chapter 206, Fridley Ciry Code
Total: �S ` � Receipt # 3a a"
INSPECTION RESULT
Approved � Denied O Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
# -
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REQUEST
Job Address: �.�� ��} � %SO/� Date: v� � ��`90�-
Owner:
Legal � No. Block Addition
Description � � f � U'ill/�f3Lf_ �
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 O Repair �!'" Relocation C'
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #��_
INSPECTION RESULT
Approved ❑ Denied � Comments __2z -� � � •-� �r.r .F >
Inspector: Date: ,�i�.T
White Copy—Inspection Dept. • Vellow Copy—Plumbing Co. • Hard Copy—Water Dept.