IR - 75104s r �
# 0041
CITY OF FRIDLEY
UTILITY LINE REPAI ELOCATION INSPECTION REGIUEST
6
Job Address: � iC' _ / t � te:� "��.
Owner. (` �_ � J
Legal '.a "°. B'°`k "°°"'°"
Description �,� � ��G.t' �_< % � � ti
Plumbing Co.TTD %��4s,,jS /%,C�U,� 8,�,�[ Master Lic. # Lf4 / 7
I agree to call for inspections after uncovering the damaged line, bebre any repairs
are made, and again when the repair is made but before recovering the line.
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Signature: .�t G ��—��l'I/1 q�
INSPECTION FEE
Water Line C?� Sewer Line D Repair ❑ Relocation ❑
Fee: �S ' UU Fee: Per Chapter 206, Fridley Ciry Code
TotaL• �S �� Receipt # 37 ���
INSPECTION RESULT
Approved ❑ Denied O Comments
Inspector: Date:
White CopY—Inspection Dept. • Yblbw Cq�y—Plumbing Co. • Hard Copy—YVater Dept.
8
6
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REQUEST
Job Address: Date:
Owner:
Legal � "� I e�«k AdOition
Description
Piumbing 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
Total: Receipt #
INSPECTION RESULT
Approved � Denied ❑ Comments ,
. a ��
Inspector: Date: � $ � � �% .
White Copy—Inspection Dept. • Y 1 Copy—Plumbing Co. • Hard Copy—Water Dept.