HomeMy WebLinkAbout806 W Laurel St - Special Inspections/Field Verification - 12/04/2020aty,of Community Development & Neig.hbortwod Swviaw
� inS 281 N College Ave; P.O. Box 580; Fort CoWm, CO W522 t1
/e�"►,� Phone. 970 2216760 FAX: 970 224 6134
Field Verification Form
Job Site �?O (O LiA Permit No,
Company Name 1 lc, t r ��t ( City of Ft Collins Uc#
V'-s- Replacement of Sewer line approx. ( 0 ft. (100 ft. maximum)
Replacement of Water tine approx. ft. (100 ft. maximum)
Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used:
Tested at � ) S s i_n � _ Lbs.
Installer Name (print)
Installer
for minutes
a
i
bate /' `(-,�02c.