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CITY OF FRIDLEY - -
UTIUTY LINE REPAIR/RE�OCATION INSPECTION REGIUEST
Job Addres • �� � ��� �D�: 'a�' �O
Owner:
I agree to call for inspections after uncrnrering the
are made, and �in when the reDqir is made
line, before any repairs
� recovering the line.
INSPECTION FEE
Water Line L4� Sewer Line L9� Repair C� Relxation ❑
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Fee: � Fee: � Per Chapter 206, Fridley Ciry Code
Total: Receipt #_-�?�:t� '�
INSPECTION RESU�T
Approved � Denied O Comments
Inspector: Date:
Whke Copy—Inspection DepL • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: Date:
Owner:
Legal � No. Block ,o�d���o„
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 R�SULT
Approved� Denied ❑ Commen � �pl/ -Q—� �. 1�t�..
� ��� ��� �_
a � „e�.�
Inspector: � Date: � �
White Copy—Inspe i Dept. • Y Copy—Plumbing Co. • Hard Copy—Water Dept.
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