HomeMy WebLinkAbout1905 Pawnee Dr - Special Inspections/Field Verification - 06/22/2015City Of I Community Development & Neighborhood Services
F6r"t Collins. 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
% Field Verification Form j�j�-6 Job Site L �d ��C/CJ/(���z x Permit No. z1 ✓m'? 7
Company Name % / O�A—ci & 11j City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum) FO/ (�l�
replacement of Water line
_/Add Replace gas line
Materials used:
approx. ft. (100 ft. maximum)
approx. ft. (50 ft. maximum)
Tested at Lbs. fory minutes
Installer Name (print) 2<,1
Installer Signature
Date 611' -22- lol�