HomeMy WebLinkAbout2807 Michener Dr - Special Inspections/Field Verification - 03/11/2013City of I I . Community Development & Neighborhood Services
Fort Collins 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
Z /
Permit No.
,E�1' ✓�Q U/ le'7
01)
Company Name w
J City of Ft Collins Lic#
acement of Sewer line
pp
approx.
ft. (100 ft. maximum)
lacement of Water line
approx.
ft. (100 ft. maximum)
Add Replace gas line
approx.
ft. ( 50 ft. maximum)
Materials used: Can n
Tested at
Installer Name (print)
Lbs. for
Installer Signature L/ /L_ IA
Date