HomeMy WebLinkAbout1805 Pawnee Dr - Special Inspections/Field Verification - 01/30/2014City of Community Development & Neighborhood Services
Fnr"t CoICollins281 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 1_ 6S I &tvh re- d.,r �I - �i)�� # 41 S GU 5 �5 Permit No. D"' J U Il6 ti �
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Company Name �I e5 }crh F�r-c f )ti,c c Svpr IV City of Ft Collins Lic#F P I � l5
Replacement of Sewer line approx. ft. (100 ft. maximum) FG- i y'
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. - ft. (50 ft. maximum)
Materials used: G kzc v, Lwin
Tested at �Ti� Lbs. fory mutes
Installer Name (print)
Installer Signature
Date 1 /3V L 1