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# 0061
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: r Date:��
Owner: v i,C��n�.� '
Ri�+a9-C�o•!�
I agree to call for
are made, and s
Signature:
2 I�- I��,�sv,� 's C�r�� u--� �a/ I�s^
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Master Lic. #
ctions er unc 'ng the damaged line, before any repairs
when the repair is made but before recovering the line.
I SPECT N FEE
Water Line � Sewer Li Repair � Relocation ❑
Fee: /� GU Fee: �S• C' Per Chapter 206, Fridley City Code
,
Total: Receipt #
INSPECTION RESULT
Approved ❑ Denied O Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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REPAIRS - REAtODELL�iG - �iF,W CONSTRUCTION
FREE ESTIb'IATES - 24 liOUR SERVICE
L[CENSED !l007432PJ
STASIK & SONS
PLUMBING
JOE STASIK 439-1�C.�tS
# , -, ..
ION REGIUEST
r 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 ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved � Denied ❑ Comments �`{'����
� � /�. �
Inspector: % Date: �— �y`� � �_
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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