HomeMy WebLinkAbout2500 Eastwood Dr - Special Inspections/Field Verification - 03/05/2015City of II Community Development & Neighborhood Services
Fort Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
/10 '� Phone: 970 221 6760 FAX: 970 224 6134
CCD Soo L_a- 466vad f ield Verification Form � 130 23 �'- a
Job Site 1 /ll 1 I ,:iZl,\ j zz,-,C4 Permit No. `J [ J
Company Name fG 2LOTCity of Ft Collins Lic# P-
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. 2n ft. (100 ft. maximum)
Add . Replace gas line approx. ft. (50 ft. maximum)
Materials used:
Tested at Lbs. for minutes
Installer Name (print)
Installer Signature
Date