HomeMy WebLinkAbout2401 Bar Harbor - Special Inspections/Field Verification - 06/28/2018City of Community Development & Neighborhood Services
Fort Collins 281 N College Ave, P 0 Box 580, Fort Collins, CO 80522-0580
/� Phone 970 221 6760 FAX 970 224 6134
Field Verification Form
Job Site ItUPlE jfiz PAr_C_ )/ Y Permit No �B11045(g,a
Company Name _3� (MS1MUCA LAB (�00_6 g — City of Ft Collins Lic#
Replac merit of Sewer line approx ft (100 ft maximum)
Wgauwt of Water line approx / oe ft (100 ft maximum)
Add Replace gas line approx ft ( 50 ft maximum)
Materials used
Tested at '1.DfJ QS� Lbs for _Ar minutes
Installer Name (print)
Installer Signature Date c3