HomeMy WebLinkAbout736 Marigold Ln - Special Inspections/Field Verification - 07/21/2020City of Community Development & Neighborhood Services
F6r't Collinsll281 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 =1�3 Ma ao1 A � Qtft (� Permit No.��D b jt) Ca'�. UQ
Company Name 1 0r �/1.P�YVI COIcaaaQ 1 tUtv�Vl 1 MCity of Ft Collins Lic#
_ Replacement of Sewer line
Replacement of Water line
Add Replace gas line
approx. ft. (100 ft. maximum)
approx. (00 ft. (100 ft. maximum)
approx. ft. ( 50 ft. maximum)
Materials used:
Tested at Mq-`����y LbLbs. for � 0 -rrr teams
Installer Name (print) V1 :�,h / ��//
Installer Signature Date { �� I LpZo