HomeMy WebLinkAbout712 Cambridge Dr - Special Inspections/Field Verification - 10/16/2017Fort 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 (�) a C.Avh6 r-44,I ,_ 6 (( ') cr16� Permit No
Company Name�KaVtDdy���lti►° 1-�yrv�b�L' J6lU�^U11S City of Ft CollinsLic# f'oiO
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 w a c It -j--fLV rJ
Tested at /,;? Lbs. for /.55 minutes
Installer Name (print) Jc, L Greve -le
Installer Signature I
Date / D >!o - / i
E