HomeMy WebLinkAbout5302 Castle Pines Ct - Special Inspections/Field Verification - 02/02/2017Community Development & Neighborhood Services
281 N College Ave; P.O. Box Slid; Fort Collins, CO 80522-0580
City .0
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[tins Phone: 06 22'1 6760 FAX: 970 224 6134
Field Verification Form
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Job Site Permit NO.
CompanyNarns Mr.. RooterPlurnbing/GDL Industries City of Ft Collins Llc# MP 844
Replacement of Sewer line approx._ ft. (100 t maximum)
Replacement of Water line approx. (s Q IL(looft. maximum)
Add ::.:..Replace gas line approx. ft. ( 50 ft. ma)dmiffn)
Materials used:
Tested at
Lbs. for minutes
Installer Nam (print) Jason Millis
Installer Signature Date
I - 116MOO*10�
Job Site
Company. Name
kdpiib*ne' nt of Sewer line
R6p1.aqftent.qf Water line
—Add Rdplace gas line
Materials used:
Tested at Lbs. for
Installer Name (print)
Community Development'& Neighborhood Services
281 N College Ave; P.O. Box 580;'fort Collins, CO 80522-0580.
Phone: 9*2216760 FAX: 970 224 6134
"cation orm
Perat No.
City of Ft' Collins Uc#
R. (100 ft. mmdmurh)
ft. (100 ft. maximum)
,ft. ( so ft. Maximum)
Installer Signature Date