HomeMy WebLinkAbout812 Rochelle Cir - Special Inspections/Field Verification - 05/27/2020r
FliCity of Community Development & Neighborhood Services
rt 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 Site SM �OG�I��I� I " 11'C_� P Permit No. &q (- k G�+ 2
Company NameKbc�e✓A Gplyrako Bvw�b�_ City of Ft Collins Lic# IAP-59-9
_ Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Waterline approx. ft. (100 ft. maximum)
_ Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used:
Tested atWDY�_OX, S rLbs. for Z4 -I S minutes
Installer Name (print)
Installer Signature
- I A
Date 5/ 2 :1- &0 Z cD