HomeMy WebLinkAbout1925 Connecticut Dr - Special Inspections/Field Verification - 06/21/2016City of Community Development & Neighborhood Services
Fort Collins 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 l L�(� EChIL i� 7e Permit No.
Company Name /V-6, City of Ft Collins Lic#jV
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Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add, Replace gas line approx. ft. ( 50 ft. maximum)
Materials used:
Tested at Lbs. for minutes
Installer Name (print) /%rGX �/ \` L� g
Installer Signature 4��j