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Home My WebLink About1320 Basseterre Ct - Special Inspections/Combustion Safety - 01/05/2016U-Zl4-5i34 City of Fdrt CoWns /'r,� tCe mbwil®a Safety Test CQ plaeemeat eff Mtatud D' &ppEUIN 2-c) � C�41 Approved Agency: g hereby attesttbat I bane pMfiff d tine following Con Fort CaffinnsCombustion Saffety Test Cluide T ecbnician dame Wd): Tecbmician 5ipature: - �ppliaace Tested: d L� Appliance replaced: a� community Development 2131 N. MllegeAve. PO BoxSBQ Fort Camns, CO GOM2 970 416,2749 970,324M34 (fax) - fixJnvcora/development Mee rWM in Exbfts Homes Permit# �3 1 tv o a 34-1 Safety Test in accordance with i 5, FebriiaEy 2412. mate 1�5 - WO, rot Case candiflow: - b Spillage 3uaation (in seconds): Carbon lfono:d it (parts ermDLon): f Pass Hail. D@L-Tested: Natiund cmlmdiflon5o Sp Maration Cm seconds): D Carbon Monamd a tpatts er M..'oa): Pass K ldaii Date Teat&& 4 5 �� .. (��%r��est} rra��es �a��o�s esaz� ii�a.��s r�ra.t�Trat►�� a�aa®ras) erlmieiall's recol�enda>�ions Yct co�ecttested appliance tare: .. l F'B ad Wont Case tCOMMO I: I ce ffy foat I am the legal owner of the above listed property has ffaRed a Combustion Sofeiy Test under worst -Ease c©ndit combustion appliance safety information sheet. ownces Vain@ (print) Owner's Signature C,9 E :MbceMendn2acal-drafi14M.12 tereby aftowledge, that my appliance I acknowledge that I have received a Date