HomeMy WebLinkAbout2826 Paddington Rd - Special Inspections/Field Verification - 01/28/2020Cityof Community Development & Neighborhood Services
Flirt 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 � / Permit No. a& av
Company Name ' 7 . i F� City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
_ Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx Cl ic. (50 ft. maximum)
Materials used:
Tested
for A0 minutes
Installer Name (print) St kyt QVN� z i ILL r1.2
Installer Signature-�����\ 1�7 41 Date _ __ %�0 / 0