HomeMy WebLinkAbout930 Gilgalad Way - Special Inspections/Field Verification - 08/06/2015City of I Community Development & Neighborhood Services
Fort 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
Job Site 1 I Ck W Permit No /
Company Name 6 City of Ft Collins Lice
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:C,�— el() 0, /)'-z' I __
Tested atIAZZ0,1 / Lb)sfor minutes
Installer Name (print)/'6T�/Y (/��1 ✓1.�� In
Installer Signature_!?/
Date /�-�