HomeMy WebLinkAbout350 Linden St - Special Inspections/Field Verification - 09/26/2012970-224-6134
11:23:46a.m. 09-28-2012 1/1
Fort Collins
Community Development & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 2216760 FAX: 970 224 6134
Field Verification Form 1 S
Job Site _ �%awSon L.u„,�p r- Permit No. \ "�
Company Name liar-,., 1Lote4z 14,oe*,c jkc, City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
_ Replacement of Water line approx. ft. (100 ft. maximum)
tCAdd Replace gas line approx. 30, ft. ( 50 ft. maximum)
Materials used: YZ t; to
Tested at /0 Lbs. for 30 minutes
Installer Name (print)
Installer Signature ie,—: . Date `� -�G -/a