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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REQUEST
JobAddress: 201 Panor ma Avenue N. Date: 4,�7/88
Owner: A11an Block
Legai � No. Blxk na,;uo�
Description 3 5 Carlson`s Summit Manor-So th
Plumbing Co.: Owner Master Lic. #
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, ani � ag�in when th� is made but before recovering the line.
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Signature: //�_
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� 3�,�IbSPECTION FEE
Water Line ❑ Sewer Line � Repair �1 Relxation ❑
Fee: Fee; 15. 00 Per Chapter 206, Fridley Ciry Code
Total: $15. 00 Receipt #�`�`-'�� ��►���
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INSPECTION RESULT ���
Approved ❑ Denied � Comments
Inspector: Date:
WhNe Copy—Inapection Dept. • Ysllow Copy—plumbing Co. • Hard Copy—Water Dept.
✓
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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job /�ddress: Date:
Owner:
Legal Lot No. Blxk Addition
Description
Plumbing Co.: Master Lic. #
1 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: -s Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESU T
Approved� Denied ❑ Comments �
iv✓b'�
Inspector. Date: � '� � — �d
White Copy—Inspection pt. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.