HomeMy WebLinkAbout1216 Fairview Dr - Special Inspections/Field Verification - 12/20/2018City.of Community Development & Heldhborhood Services
WF„�t Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 2216760 FAX: 970 224 6134
Field Verification Form
Job Site I O-A to rn&lzt" 4 1V Permit No.
Company Name City of Ft Collins Lic# 2�S LA
Replacement of Sewer line approx ft. (100 fL maximum)
_ Replacement of Water One • approx. fL (100 fL maximum)
_ Add _ Replace gas line approx ft ( 50 fL maximum)
Materials used: Vk M04- L.,- '9eAA1,g
Tested at Lbs. for minutes
Installer Name (print) AAX
Installer Signature pate