HomeMy WebLinkAbout754 Rochelle Cir - Special Inspections/Field Verification - 07/02/2015Fort Collins
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
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Job Site �s�� - �� Permit No. &17— I ® I
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Company Name City of Ft Collins Lic#�
Replacement of Sewer lint approx. ft. (100 ft. maxi um) —
eplacement of Water line approx. ft. (100 ft. maximum)
_Add Replace gas line
Materials used:
Field Verification Form
approx. 4-0 ft. (50 ft. maximum)
Tested at RS l Lbs. for 1S minutes
Installer Name (print) W
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Installer Signature �G d 1145L 'b 0c/\_ ' �
Date / = r 4