HomeMy WebLinkAbout5518 Fossil Ct E - Special Inspections/Field Verification - 08/24/2012City of
,art Collins
Community Development & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site 55��4,��,t�. Permit No.
Company NameY/ 0 0ALf/Y!?`�• 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)
Materials used:
Tested at
Lbs. for minutes
Installer Name (print) C C S ti�U
Installer Signature
Date ✓4 / �r�