HomeMy WebLinkAbout1725 Barnwood Dr - Special Inspections/Field Verification - 03/11/2013Fort Collins
Job Site
Compan
Replacement of Sewer line
placement 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
Add Replace gas line
Materials used: lam) pa ':5�-
Tested atjitJlJiI� Lbs
Permit No. d �'-)e/'�
City of Ft Collins Lic# %%% — 67191
approx. ft. (100 ft. maximum)
approx. ft. (100 ft. maximum)
approx. ft. ( 50 ft. maximum)
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Installer Name (print)
Installer Signature vC�
Date /