HomeMy WebLinkAbout110 N Sherwood St - Special Inspections/Field Verification - 03/28/2017City of
F 5rt COltins
Community Development &Neighborhood Services
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 (j I S�AecW00a St• Permit No.
Company Name oo+er € t- . rndusIrJ ['S City of Ft Collins Llc# til P
✓ Replacement of Sewer line approx. (0 O ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add,. ` Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: 5�� tfU• 'in Mowrnh;� 5La,n&f.'du4j-5pLe%p CI&4,r0144
Tested
Lbs. for minutes
Installer Name (print) (�GtSdV1 wJ hC2
Instal of r Signature -- —- - -
Date 511,28Z) 7