HomeMy WebLinkAbout411 E Plum St - Special Inspections/Field Verification - 02/08/2010Fort Collins Building & Zoning Department
281 N. College Ave. • P.O. Box 580 • Fort Collins, CO 80522-0580
Voice: 970-221-6760 • FAX: 970-224-6134 S�
City of Fort Collins
Field Verification Form
Job Site �� ate, & f Permit No.
Company Name City of Ft. Collins Lic. #
Replacement of Sewer Line approx.
Replacement of Water Line approx.
ft. (100 ft. maximum)
ft. (100 ft. maximum)
-X Add Replace Gas Line approx. �%' ft. ( 50 ft. maximum)
Materials used: 3z4� ii Z�-C=
Tested at 1/� lbs.
Installer Name (print)
Installer Signature
for / minutes
r/
Date