HomeMy WebLinkAbout1236 Truxtun Dr - Special Inspections/Field Verification - 12/22/2011City of Community Development & Neighborhood Services
Fort Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
11' Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site ► 136, T r U x T o n/ b r i Permit No. Q I 1 o 1 5 J C
Company Name 0 P` V 0 i' i �(? Jo Ly m b ' � 15 City of Ft Collins Lic# ir%/e-2`�7�
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
t//Add Replace gas line approx. 4 Q ft. ( 50 ft. maximum)
Materials used: G i� S r l `t � T C S S-r
Tested at r o Lbs. for 30 minutes
Installer Name (print) K e- i 11 R 4 c e.T fie
Installer Signature '% '/L� Date 1 ��