HomeMy WebLinkAbout300 E Lincoln Ave - Special Inspections/Field Verification - 06/15/2017Fort Collins
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 iyl/ �i- L- / {�C_FJ��� Permit No.
L7
Company Name rl� L* I City of Ft Collins+Lic
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_Replacement of Sewer line approx. ft. (100 ft. maximum) oWca rS
Replacement of Water line approx. ft. (100 ft. maximum)
_ Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: s �) R 3:6 1 PVC -
Tested at �J 1 C7 Lbs. II for minutest-'
Installer Name (print) J'-e- r
Installer Signature �� � �� . Date 6( 15 / LY-1