HomeMy WebLinkAbout3340 Rookery Rd - Special Inspections/Field Verification - 10/04/2018City of 1 Community Development & Neighborhood Services
Fort Collins 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 _ -�.3-�!y �bD J��%L� 2�L Permit No.
Company Name_ 1�J�i���d/�1 �1 /,//i%1� f� �t/��/�5 City of Ft Collins Lic#
_ Replacement of Sewer line approx. ft. (100 ft. maximum)
_ Replacement of Water line approx. ft. (100 ft. maximum)
Add JJ Replace gas line approx. �((L ft. ( 50 ft. maximum) ! +
Materials used:(' �`1 ��,� 41 ( 14;(.{-7L: f I �, `�5T +.. l�Y'
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Tested at (� Lbs. for minutes i oiY�
Installer Name (print) .. 1 - vn
Installer Signature ��� Date 1 Q) ��