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CITY OF FRIDLEY
UTILITY LINE REPAIR/R LOCATION INSPECTION REGIUEST
Job Address: � �(.�I (% �[ / Date: �� "�� � �1(r�
Owner: A AJN � l�D� �f l�l F- i C(
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Plumbing Co.:l�/��� �D Master Lic. # <<��
I agree to call for inspections after uncovering the damaged line, before any repair5
are made, an ga' whe the repair is made but before recovering the line.
Signature:
INSPECTION FEE
Water Line PJ Sewer Line ❑ Repair � Relocation �
Fee: �S � Fee: Per Chapter 206, Fridley City Code
Total: �� • �iC� Receipt #
INSPECTION RESULT
Approved ❑ Denied O Comments
Inspector: Date:
White 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 Address: Date:
Owner:
Legal � No. Block 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
Inspector: ����� �� Date: � z"/ � ���1�
White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept.