HomeMy WebLinkAbout2838 W Elizabeth St - Special Inspections/Field Verification - 09/19/2016% Ly 01
Fort Collins
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Community Development & Neighborhood Services
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 �4 3 L 2-l� J1 Fr Iv"�� Permit No. 05 3& 7—
Company Name e5 tG�'i'1 �'� �`C ,y0 /&LC C /' City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
x� Add Replace gas line approx. 3�J— ft. (50 ft. maximum)
Materials used: 3 f 4, 0 f 3AI � � 614.5 h t—
Tested at Z®
Installer Name (print) T iZ 13401
Lbs. for Q minutes
FAA
n/ Installer Signature l 1 Date