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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
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Job Address: � -`� d � �-�-�a..�9�. L�o�-�. Date: �� � � � i�
Owner:
Legal �a wo. sack �ea�u
Description � a �_� (.�1�.L1. `S ¢�j V��S �,�
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Plumbing Co.: � o�.�-�+.�� ��� Master Lic. #
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.
Signature: �nN �r'VYY`iW�,
INSPECTION FEE
Water Line $! Sewer Line ❑ Repair ❑ Relxation O
Fee: �� o o Fee: Per Chapter 206, Fridley Ciry Code
Total: � Receipt # ��
5� ��i.l,°��t �rtlA t G zi
°�' � �Q � �_ „ Q �rh �, ti . INSPECTION RESULT
�o.� � f'�' �
ppr�iea'O� n�"ied ❑ Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legai I�� "° I e��k I Addition
Plumbing Co.: Master Lic. #
1 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 rJ Repair ❑ Relocation C!
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt # '
,SO ��1_ 2�-����f�
dJ c�`,�INSPECTION RESULT
�o�(,�e-� � ' �
Approved � Denied � Comments
Inspecto � Date: ,�� �
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.