HomeMy WebLinkAbout244 N COLLEGE AVE - SPECIAL INSPECTIONS - 1/8/2014Fort Collins
Community 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 al4q nki Lol
Company Name
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Permit No. d/-12 7Z
City of Ft Collins Lic# — a/
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
�Add 0f Replace gas line approx. ft. ( 50ft. maximum)
Materials used: PK cart .'t (f,amt , Scl'. L10 614d< a4l k
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�Tested at li r64f $O Lbs. for h .2 Aminutes
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Installer Name (print) J eao►t, 4 6-s.vo
Installer Signature /;=�
Date I "y