IR - 75108. � ���?- �� �,� �,.
# 0� 045
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: ��� �_ C,, � i=� c/ LU �Z �� l Date: ��> 1.s
Owner: U�r /Z l S --5�� /�O �< �
Plumbing Co.:_
I agree to call for
are made, and �
��I� l�'f�i ���.� Master Lic. # ��
ctions after uncovering the damaged line, before any repairs
when the repair is made but before recovering the line.
INSPECTION FEE
Water Line ❑ Sewer Line �" Repair � Relocation ❑
Fee: 25 . 00 Fee; 25 . 00 Per Chapter 206, Fridley Ciry Code
TotaL• Receipt # � � �3
INSPECTION RESULT
Approved ❑ Denied � Comments
Inspector: Date:
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
# d
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: Date:
Owner:
Legal Lot No. Blotk Addition
Description
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 O Repair ❑ Relocation C'
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved� Denied � Comments ybL/SG SEW�RS�RIOI�'.L
� R��c�1 Ar /�ri�: Fa�Ti�Us
Inspector: Date: n — �' 9J`�
White Copy—Inspeclion Dept. • Y Copy—Plumbing Co. • Hard Copy—Water Dept.