HomeMy WebLinkAbout2017 W Plum St - Special Inspections/Field Verification - 01/08/2015City of I I . Community Development & Neighborhood Services
Fnr't Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
`�"r Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site 2&-1- / W�-`sI Permit No. E ` LI 2 13
Company Name City of Ft Collins Lic# - �Z
l� Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: e T f 1- L i A Q f 12Q � p
Tested at Lbs.for minutes
Installer Name (print) 5Ao klR
L P, A p -1- AC • ) C(
Installer Signature 9�� Date