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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION IN,SPECTION R GlyE
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Job Add ess Date.
Owner. � - �' �'�-��
Legal � N . Block naa�n«� /�
Description t�f} ' � �/�of�c�i��� �oA�4�Ns
Plumbing Co.• ` '�✓� /✓��-�aster Lic. # ��ff
I agree to call for ins ions after uncovering the dama line, repairs
are made, and a e the r ir is made o e' he line
Signature: f "�^�
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INSPECTION FEE
Water Lin� Sewer Line � Repair � Relocation O
Fee: �� QP Fee: Per Chapter 206, Fridley Ciry Code
Total: ��- � � Receipt # � ��--
INSPECTION RESULT
Approved ❑ Denied � Comments
Inspector: Date:
WhHe Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REt�UEST
Job Address:
Owner:
Date:
Legal � No. Block I nca;,,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 �; Sewer Line D Repair ❑ Relocation ❑
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved `'� Denied � Comments
Inspector: Date: ` �
White Copy—Inspection ept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.