HomeMy WebLinkAbout2632 Somerville Dr - Special Inspections/Field Verification - 07/31/2017Fort 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
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Job Site 3� S ��'itv ���� �i�- Permit No
Company Name City City of Ft Collins Lic#
Replacement of Sewer line
Replacement of Water line
Add�!- "9&ee gas line
Materials used 3
approx ft (100 ft maximum)
approx ft (100 ft maximum)
approx ft (50 ft maximum)
Tested at /4P Lbs for minutes
Installer Name (print)
Installer Signature Date—��—�
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