IR - 75092#_0030
CITY OF FRIDLEY �
UTILITY LINE REPAIR/RELOCATION INSP ION REOUEST
Job Address: � ` � / �� � ate: �' �3 � �
Owner: S �" 1-L (� j—rY
Legal �a No. e�ock �aan�oo
Description � �;� � ��jA-i �,Qf
Plumbing Co.: [y' i�''� tP L 7 � Master Lic. #
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, and agy�ir� when the,�rE3p�air ��rmade but before recovering the line.
INSPECTION FEE
Water Line � Sewer Line ❑ Repair � Relocation ❑
Fee: 1�'� � Fee: Per Chapter 206, Fridley City Code
Total: Receipt # /o y(c�
INSPECTION RESULT
Approved ❑ Denied ❑ Comments
Inspector: Date:
White Copy—Inspeclion Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Weter Dept.
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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal ( �Ot No. I eio�k nadrt�o�
Descriotion
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 G Sewer Line � Repair ❑ Relocation C
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved � Denied ❑ Comments
Inspector: Date: (l �� Y_.r�`� ��
White Copy—Inspection ept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.