HomeMy WebLinkAbout5939 Twin Wash Sq - Special Inspections/Field Verification - 09/12/201809-10-'18 15:01 FROM- Mr Rooter Plumbing 303-772-4499 T-101 P0001/0001 F-324
Q!Of�O��it t5 Community Development Bt Neidhborhood Services
281 N College Ave; P.O. Box $00; Fort Collins, CO 80522.0580
Phone: 970 2216760 FAX: 970 224 6134
_ Field Verifleation Form
Job 5ne Z S 7� (4 h//* Pem,n No. �i rSD 15 "� �i
Company Name _M r' "prr/ a. � , City of Ft Collins Llo# M T Wk
Replacement of Sewer line approx. _1� ft. (100 ft. maximum)
Rep1808ment of Water line • approx. ft. (100 R. maximum)
_ Add, Replace gas line approx. ft. (50 ft. maximum)
Materials used: —c56%Z 3 S Z A c rMsfc, m C E
Tested at Lbs. for minutes
Installer Name (print) 540 f! OnOK
Installer Signature
Data V� D //