HomeMy WebLinkAbout713 Mathews St - Special Inspections/Field Verification - 11/20/2020Fort Collins
Community Development & Neighborhood Services
281 N College Ave; ns, CO 80522-0580
phone: 97082216760 0; Fort oIIiFAX: 970 224 6134
N/► p�-, Fieldt Verification Form /�
Job Site J" I - 98c�, 1 or'4CA`�� ( JcCo bZZq Permit No. �`'
Company Name r `� City of Ft Collins Lic#
100 ft. maximum)
Replacement of Sewer line ap x. ft. (
_ Replacement of Water line approx. ft. (100 ft. maximum)
Add _ Replace gas line approx. RL ft. ( 50 ft. maximum)
Materials used:
Tested at 2D�j95c ,-�1 Lbs. for minutes
Installer Name (print) low
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Installer Signature d-- �-
Date 1 t d Zy w 20