HomeMy WebLinkAbout3525 Auntie Stone St - Special Inspections/Field Verification - 11/22/20171
' FCityof
6rt 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
fn-k� Lo2oN Field Verification Form
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Job Ste� ?Company Namel-nA4- '4W1 1-kA-V 1) V'tAk M
Replacement of Sewer line
Replacement of Water line
X Add Replace gas line
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Materials used' J I o 0 p t(
Permit No
City of Ft Collins Lic#
approx ft (100 ft maximum)
approx. ft (100 ft maximum)
approx. %5 ft (50 ft. maximum)
Tested at '- d Lbs. for -20 minutes
Installer Name (print) /p/i4 1 I I (l�
Installer Signature
Date 2-`�