HomeMy WebLinkAbout202 Peterson St - Special Inspections/Field Verification - 08/30/2012City of
Fort Collins
Job Site
Company Name
/
✓ Re
Replacement of Water line
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
Permit No.
City of Ft Collins Lic#
ft. (100 ft. maximum)
ft. (100 ft. maximum)
Add Replace qas line aoprox. ft. (50 ft. maximum)
Materials
Tested at Lbs. ,y for
g2C4/ minutes
Installer Name (print) hd
Installer Signature
Date 9/a q'/