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IR - 75111.: '� �� . � � # �D4 CITY OF FRIDLEY UTILITY LINE REPAIR/RELOCATION INSPECTION REQUEST Job Address: � � �� /�� Date: � � Owner: �'/i iYl l �'-�_ Legal � No. Block Addition Description �,�"J /n / � � � �L�.� i � Plumbing Co.: f� 1�F" lC [ tt H I Master Lic. #�� I agree to call for inspections after uncovering the damaged line, before any repairs are made, and aga'��,n when the repair is made but before recovering the line. Signature: /' .c Gc �,Q.vtri� INSPECTION FEE Water Line L� Sewer Line ❑ Repair � Relocation ❑ Fee: l� Fee: Per Chapter 206, Fridley City Code TotaL• �s" �� Receipt # INSPECTION RESULT Approved O Denied ❑ Comments Inspector: Date: White Copy—Inspeclion Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept. � # , CITY OF FRIDLEY UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST Job Address: C J� (i� / l�( �fk� !V �_ Date: Owner. Legal I�O1 NO B��k 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 I;� Sewer Line ❑ Repair� Relocation ❑ Fee: Fee: Per Chapter 206, Fridley City Code Total: Receipt # INSPECTION RESULT Approved �Denied ^ Comments Inspector. � Date: �`S�' 7n � White Copy—Inspection Dept. • Yellow Copy—Plumbing Co. • Hard Copy—Water Dept. ✓ ,