HomeMy WebLinkAbout2307 Stonegate Dr - Special Inspections/Field Verification - 05/03/2017City of Community Development & Neighborhood Services
F6r"t Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Feld Verification Form
Job Site Permit No 110 ? 864
Company Name fdo 4 5�6)f D City of Ft Collins Lic#
_ Replacement of Sewer line
Replacement of Water line
Add Replace gas line
Materials used:
Tested at --?
Installer Name (print)
Installer Signature
approx. ft. (100 ft maximum)
approx ft. (100 ft maximum)
approx. ft ( 50 ft. maximum)
for /- minutes
Date /