HomeMy WebLinkAbout120 W Stuart St - Special Inspections/Field Verification - 01/11/2017 (2)City, Of Community Development & Neighborhood Services
Fort Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 2216760 FAX: 970 224 6134
Fie�l�dJ Verification Form
Job Site 11.20 Yl/ k W Permit No. B 11c0-1(oO
Company Name t,w / G City of Ft Collins Lic# 191Q�
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas linne approx. obi O ft. (50 ft. maximum)
Materials used: C,557r a4�-
Tested at lv Lbs. for minutes
Installer Name (print) l-
Installer Signature ti
Date ( it 7
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FCC e-&Lce, inspec4torn
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