HomeMy WebLinkAbout4249 Kingsbury Dr - Special Inspections/Field Verification - 09/24/2018Fort Collins
Community Development & Neighborhood Services
Fort 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 SiteAa L-1 6� YVAcs6l-'420� O r Permit No. b l io -mi L l
Company Name yr "cl;'nk Soly+\f Un k' City of Ft Collins Lic#!(Y�
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used:
Tested at /D Lbs. for �?e) minutes
Installer Name (print) <e,
Installer Signature
s
Date / " I 1 ` I a