HomeMy WebLinkAbout218 Smokey St - Special Inspections/Field Verification - 12/08/2017City of
Fort 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 k.\ Ca-
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Company Name 1Nkcll t-) r _r�
Replacement of Sewer line
Replacement of Water line
Add Replace gas line
Permit No. 1 i -709 3 q
City of Ft Collins Lic#
approx. ft. (100 ft. maximum)
approx. 6C) ft. (100 ft. maximum)
approx. �(XL ft. ( 50 ft. maximum)
Materials used: �J( Q ' ` ,�rv!� 1 ix� S !�(pP. �-Aym °
Tested at
:;2
Lbs. for
minutes
Installer Name (print/Y N,%&Ai [� \/t1M�m�cl�
Installer SignatuL�2 Date 1