IR - 750800
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�I�(��°�RIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: �� �! 9 / �`��J� -�� ��- Date: � � ��
Owner: _ At ( �P,4 J �N�)Sor�
Legal �a wo. ew�k naamo�' /.
Description / � ��1/Ll�I�f�c.ta /-�f� r(' ��S
Plumbing Co.: ��'�� �S �'-�/+�2. f{ �``�`Master Lic. #
I agree to call for inspections after uncovering the damaged line, bef�ore any repairs
are made, and ag i when the re air is� de but before recovering the line.
Signature: �"�'"7''�'' 1 7 �C.�`°` ��''�"'
Water Line ❑
Fee:
INSPECTION FEE
Sewer Line �I Repair ❑ Relocation ❑
Fee: _1� Per Chapter 206, Fridley City Code
Total: Receipt #.
INSPECTION RESULT
Approved ❑ Denied O Comments
Inspector: Date:
WhHe Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.
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#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job
Owner:
Date:
Legal � No. Blotk naa+uo�
Descriotion
Plumbing Co.: Master Lic. #
I agree to call for inspections after uncrnering 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 C Sewer Line ❑ Repair� Relocation C
Fee: Fee: Per Chapter 206, Fridley City Code
Total: Receipt #
INSPECTION RESULT
Approved� Denied ❑ Comments .t1'�!�� ����`'�A ��� ^�: A
.Wrta..,�;YLo�'la.►.. Q� al'►�c
Inspector: ' . • Date: c� — � ` �%
White Co Inspection Dept. • Yel Copy—Plumbing Co. • Hard Copy—Water Dept.