HomeMy WebLinkAbout2424 Cucharas Ct - Special Inspections/Field Verification - 03/17/2015Eal :5'. 3 -aa -i.
City of I Community Development & Neighborhood Services
Flirt 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 p2my ifine,4.o2AS CT• Permit No. &iLtIj.5-S-7
Company Name &riw wK p4�Ir• City of Ft Collins Lic# a�LQo2S�i
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. 9� ft. ( 50 ft. maximum)
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Materials useV4 "/ "i3LACY- A PE 3 - /.x9.0 uN /n � , 6.a5 cD4,v—
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Tested at /O Lbs. for 1,5- minutes
Installer Name (print)
Installer Signature /� Date 311' /� S