HomeMy WebLinkAbout2414 Treestead Rd - Special Inspections/Combustion Safety - 03/25/201311
rCityoff Community Development & Neighborhood Services
F6r"t Collins 281 N College Ave; P.O. Box 0 22 Fort Collins, : 9i7 0522 6134
'+�' Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site ;z lu f te4G h . A - Permit No. 13) 3 D O $I d
Company Name ra kd*' �� N� City of Ft Collins Lic# 7
Replacement of Sewer line approx. ft. (100 ft. maximum) / iP 3/'
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx._ ft. (50 ft. maximum)
Materials used:
Tested at Lbs. for minutes
Installer Name (print) 4e�'VAI-
Installer Signature Date 3r' CZ5 —