HomeMy WebLinkAbout221 S Grant Ave - Special Inspections/Field Verification - 03/11/2019City of . Community Development & Neighborhood Services
F6rt Collins"281 N College Ave; P.O. Box 580; Fort Collins,
Phone: 970 221 6 60X 970 224 6134
V/ Field Verification Form p �r
Job Site C;�/ Permit No.
Company Name a" City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
1,"'�Add Ljr Replace gas line approx. _:S- ft. ( 50 ft. maximum)
Materials used:
Tested at 1 Lbs. for
Installer Name (print) 4-S�C&,ni AoA%P.,1k,;L
Installer Signature 'ze- t- /Vl/
minutes
Date a, ^ 2 V - `