HomeMy WebLinkAbout2216 Loyola Ave - Special Inspections/Field Verification - 09/19/2019City of
Fort 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
Field Verification Form
Job Site a-Z) t L-U y o I C, AV-6 F f. Co I I J,h
Permit No. `u Iq 10,5 � �
Company Name V t° 5 �1- � C��rC o S uef City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. 5- .S ft. ( 50 ft. maximum)
Materials used: 2, S � t i314C h 17rorl
Tested at 10 / Lbs. for to minutes
Installer Name (print)
Installer Signature �I� ��'`� Date