HomeMy WebLinkAbout4430 Stoney Creek Dr - Special Inspections/Field Verification - 12/14/2017City of Community Development & Neighborhood Services
Fort Collinsll281 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 ('.�'P.�, .� � Permit No.
Company Name N n(-- nA ,fr. S�Q U w i2 � 1 j City of Ft Collins Lic#
/Replacement of Sewer line approx. ft. (100 ft. maximum)
;/ Replacement of Water line approx. moo_ ft. (100 ft. maximum)
Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: ( C�e r -�5 CC%,N\ R C:L- 5 � C)a
Tested at
Lbs. for
Installer Name (print) a �(
Installer Signature
minutes
Date `� I S
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