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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REQUEST
JobAddress: 5650 Polk Street N.E. Date: 9�6/90
Owner. 32 Unit Apartment
Legal � No. Blxk ,�a�u�,
Descriotion 3, 4, 5 Aud. Sub .#2 5
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Plumbing Co.: ` i. Master Lic. #��� � � � � � �
I agree to call r inspections aRer uncovering the damaged line, before any repairs
are made, a� aga' h n r air i but b recovering the line.
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INSPECTION FEE
Wate� Line �� Sewer Line ❑ Repair �J Relocation �
Fee: 15 .00 Fee: Per Chapter 206, Fridley City Code
Total: 15 . 00 Receipt #—=��r J��
INSPECTION RESUI.T
Approved ❑ Denied � Comments
Inspector: Date:
White Copy—Inapection Dept. • Yellow 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 Lot No. Blotk Addition
Desrri�tion •
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 ❑
Fee: _ Fee: Per Chapter 206, Fridley City Code
Totaf: - Receipt #_
INSPECTION RESULT
Approved � Denied O mments
Inspector: Date: ! ' �� � �
White Copy—Inspection Dept. • Yellow Copy—Plumbinq Co. • Hard Copy—Water Dept.