HomeMy WebLinkAbout1007 Kremmling Ln - Special Inspections/Field Verification - 10/20/2006R.
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Job Site
m
Fqrt Collins. Building & Zoning De
281 N. College Ave. • P.O. Box 580 • Fort Collins, CO
Voice: 970-221-6760 9 FAX:970-27A-6134
Field Verification Form
Permit No.
rtment
Company Nam t r
P Y City of Ft. Collins Lie. # I
_ Replacement of Sewer Line approx. ft. (100 ft. Irrtaximum)
_____ Replacement of Water Line approx. ft. (100 ft. maximum)
Add - Replace Gas Line approx. ft. ( 50 ft. maximum)
Materials used:
I
i esiea at
lbs. for
minutes
Installer Name (print)' r S
1�7
Installer Signature Date 110-2,0
17