HomeMy WebLinkAbout130 Lyons St - Special Inspections/Field Verification - 07/24/2013City of Community Development & Neighborhood Services
F6r't Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
1/ ,�``"' Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site 130 ty6n --5 f & Co I I 66s Permit No. /✓ �y ��
Company Name fry or Plu..►A h ` City of Ft Collins Lic#/%7p,3 �L7
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. :Z 5 ft. ( 50 ft. maximum)
Materials used: TY0.¢ Ge. a4 Rrc ld h'IK Pr4e �r► l "5
Tested at
Lbs. for L0 minutes
Installer Name (print)
Installer Signature
Date 7 - Z / — 1 3