HomeMy WebLinkAbout641 S TAFT HILL RD - SPECIAL INSPECTIONS - 3/6/2009Fort Collins Building & Zoning Department
U� 281 N. College Ave. - P.O. Box 580 a Fort Collins, CO 80522-0580
Voice: 970-221-6760 - FAX: 970-224-6134
Cityof.Fort Collins
Field Verification Form
01
Job Site __ - !.S G �e Permit No. 1��]
_
- ---- - -
Company Name City of Ft. Collins Lic.
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Replacement of Sewer Line approx.�)ft. (100 ft. maximum)
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Replacement of Water Line approx. ft. (100 ft. maximum)
Add _ Replace Gas Line approx. ft. ( 50 maximum)
Materials used:
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Tested at _ lbs. for minutes
Installer Name (print), 1
Installer Signature -44- y`1l Date - d�� 0 f (,cl _