HomeMy WebLinkAbout3645 Muskrat Creek Dr - Special Inspections/Field Verification - 04/30/2012Fort Collins
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
Job Site 36y S/► Mvi s lurci1il� 1�� btu Permit No.
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Company Name ( ,t t-(' Wl tY'On 7-I t Q ` 1C City of Ft Collins Lic# 1I ° ° �i
Replacement of Sewer line approx. ft. (100 ft. maximum)
_ Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. 50 ft. ( 50 ft. maximum)
Materials used: tuts + e
Tested at
10
Lbs. for 3 <O minutes
Installer Name (print) M 1�� �fZ�oa���✓
Installer Signature ^
Date A p l"\ I � Tj