HomeMy WebLinkAbout4112 Sunstone Dr - Special Inspections/Field Verification - 12/22/2015City of I Community Development & Neighborhood Services
Flirt Collins 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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Field Verification Form
Job Site. 1�'J 3�J tli�l('� /4)�7V5To-k: —Permit No."15yi�%.�'�
Company Name JL�jZ ,�1 r!fs L 11 t�� r�;�Ltl City of Ft Collins Lic# 'C�-1 (! %
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Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. Cm� ft. ( 50 ft. maximum)
Materials used: C.J51— () di-s ice Z=
Tested at 6 Lbs. for �J p_ minutes
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Installer Name (print)
Installer Signature - ` Date