IR - 75107a
1�"'�+ � °2 " /
# 0044 �
CITY OF FRIDLEY
UTILITY LINE REPAIR/ ELOCATION INSPECTION RE�UEST
Job Address: � `� � �". � I S t� -A-ri- � � _ Date: 'y - / / - 9S �
Owner: / t�Z .��-
L@gal �a No. s�ock nddition�7
Description � � ��f f2 i Q q ti� i,fC� �QF S
Plumbing Co.�%°.�� C��_�� fi Master Lic. #���� �O'�
I agree to catl for inspections after uncovering the damaged line, before any repairs
are made, and a hen the repair is made but before recovering the line.
�,��,�,,.o. ��..�; �� �-�.�� 9�v - �'�y�
INSPECTION FEE �� "
Water Line Cg� Sewer Line � Repair L� Relocation ❑
Fee: /S , D v Fee: Per Chapter 206, Fridley City Code
Total: l� �/� Receipt #
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Capy—Water Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/ ELOCATION INSPECTION RE�UEST
Job Address: ( � S� Date: "�
Owner:
Legal � �a r,o. I e�«k I Atldition
P�umbing 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: 9�%U' 91o�%L�
INSPECTION FEE �i /r
�if
Water Line �' Sewer Line � Repair � Relocation C
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved� Denied � Comments
Inspector• ^ Date: '`�l o� �� � c�
White Co —Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.