HomeMy WebLinkAbout700 Breakwater Dr - Special Inspections/Field Verification - 02/28/2003Fort Collins 6uildin Z •
g Zoning Dept
281 N. College Ave. • '
City of Fort Collins Voice: 970 2021 6760 80 Fort Collins, CO 80522-0580
FAX: 970-224-6134
Field Verification
Form
Job Site 700
Permit No. IDMI
Company Name�alrA 1:1
City of Ft. Collins Lic. #
Replacement of Sewer line approx.
Replacement of Water line approx, ft. (100 ft. maximum)
ft. (100 ft. maximum)
Add Replace gas line approx.
Materials used: ft. ( 50 ft. maximum)
i ested at i --? lbs. 15
for minutes
Installer Name (print) _/�,vif F sK��-��ti
Installer Signature _ .
Date