HomeMy WebLinkAbout2931 Rocky Mountain Ct - Special Inspections/Field Verification - 03/15/201604/11/2016 10:02 9704612413 KAHAR PAGE 01
Fort Collins
Community Development & Neighborhood Services
281 N College Ave; P.O- Box 580; Fort Collins, CO 80522-05$0
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site �� 71I�C4 WO tom" CA- Permit No. S/6 0 1 , qC1-,"
Company Name City of Ft Collins Lic#
Replacement of Sewer line / approx. ft. 0 00 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. -a ft. (50 ft. maximum)
Materials used.
Tested at i Ci
Lbs. for minutes
Installer Name (print),' +
Installer Signature -- rzZ or Date ; 1-7
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