HomeMy WebLinkAbout1313 Robertson St - Special Inspections/Field Verification - 07/03/2020Community Development & Neighborhood Services
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
Permit No.
Company Name �`q&kVl P "INQ&4-LQ4 City of Ft Collins Lic# 1
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft.
Add Replace gas line approx. 30 ft. ( 50 ft. maximum)
Materials used: 35
Tested at Lbs. for 3b minutes s
Installer Name (print) 1A
Installer Signature_._, Date ' 3 ` `V
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