HomeMy WebLinkAbout2507 Bar Harbor Dr - Special Inspections/Field Verification - 03/05/2013Fort Collins
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Community Development & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site 2SU � A.. "- Permit No. P 1300,5- S
Company Name City of Ft Collins Lic#. � y
Replacement of Sewer line approx. ft. (100 ft. maximum)
Ra ement of Water line approx. -7-G ft. (100 ft. maximum)
Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: /u I �i .I n /; , u y �� S
Tested at S Lbs. for 16 minutes
Installer Name (print)
Installer Signature ~ ? �� Date 7 t-
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