HomeMy WebLinkAbout6550 Finch Ct - Special Inspections/Combustion Safety - 09/06/2013Planning, Development & Transportation Services
ity O� Community Development & Neighborhood Services
C(f 281 North College Avenue
F6rt VOLT' ns Fort Colli s8 CO 80522.0580 RE p;q+�� - LI
`�. 970.418.2740. SEP — 7 209
970.224.6134- fax
fcgov.com
BY:
Combustion Safety Test Compliance Form
Replacement of Natural Draft Appliance
Address: SSa f i tih C� . �G'r t� 5Permit Number: 130 Lill 0
Contractor/Agency: &`fa Equipment Replaced: Natural Conditions: Pass 1/ Fail Date Tested / `
2-0 /3
(Failed test requires corrections until Natural Conditions test passes)
Worst Case Conditions: Pass L/ Fail Date Tested O 9/ 06 4?D
Failed appliance information:
(Failed test requires owner's signature acknowledging results.)
I certify that I am the legal owner of the above listed property and hereby acknowledge that my
appliance has failed a Combustion Safety Test under worst -case conditions.
Owner's Name (print)
Owner's Signature