HomeMy WebLinkAbout2124 Eastwood Dr - Special Inspections/Field Verification - 12/28/2007Z0'd _Id101
Fort Collins Building & Zoning Department
281 N. College Ave. • P.O. Box 580 • Fort Collins, CO 80522-0580
Voice: 970-221-6760 • FAX: 970-224-6134
Field Verification Form
Job Site Z. t 7_H ES-t`W o a D r `ye Permit No.
Company Name W25fe<<n R'=Ioae 5tAO8� City of Ft. Collins Lic. #
Replacement of Sewer Line approx.
ft. (100 ft. maximum)
Replacement of Water Line approx. ft. (100 ft. maximum)
Add —Replace Gas Line approx. ft. ( 50 ft. maximum)
Materialsused: Fixed m-Leq�lc, ;^ aa5 (ige,
Tested at l5
lbs. for t5 minutes
Installer Name (print) C,7A r)slo,e/,a r 6 0 wl (.1
Installer Signature 4�: /%2 Date /T�2?Z6) %
S0/i0'd 8689S6b0L6 AiddnS 33ti-1d321Id Na31S3M ZS:LZ L00Z-8Z-J3Q