HomeMy WebLinkAbout4400 Stoney Creek Dr - Special Inspections/Field Verification - 04/11/2013City of 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 OO 571n� l.�..�(-'A%6-, �T�'/ir S�� PermitNo.'_
Company Name iLO City of Ft Collins Lic# /CEO
_ Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add _R�eeplace gas lines r„approx. _n ft. ( 50 ft. maximum)
Materials used: CJJ lla-4- -bEQ �/ n
Tested at /l Lbs. for
Installer Name (print)
Installer Signature
minutes
Date #ll