HomeMy WebLinkAbout301 E Prospect Rd - Special Inspections/Field Verification - 12/16/2014Pcityof Community Development & Neighborhood Services
~/,rt Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
6r Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site �� Is� Permit No������
Company Name ���l�j�i���Y>C City of Ft Collins Lic#
Replacement of Sewer line approx,�U ft. (100 ft. maximum)
_ Replacement of Water line approx. ft. (100 ft. maximum)
Add �� Replace gas line approx. �� ft. ( 50 ft. maximum)
Materials used: 21 'e7LIZ
Tested at / O Lbs. for 16— minutes
Installer Name (print) Z�'f.5 rJIA�/iE�
Installer Signature Date