HomeMy WebLinkAbout619 BLUE MESA AVE - SPECIAL INSPECTIONS - 4/20/2004Fort Collins Building & Zoning bept.
281 N. College Ave. • P.O. Box 580 • Fort Collins, CO 80522-0580
City of Fort Collins Voice: 970-221-6760 •FAX: 970-224-6134
Field Verification Form
Job Site _ l/v��3� Permit No. �o3colZ &O
Company Name lleo -/ 55c: C_ City of Ft. Collins Lic. # 1"(9-1
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
�dd Replace gas line approx. ! 5r �—t— ft. ( 50 ft. maximum)
Materials used: f 7Y ®,
Tested at %e9 LA-5-- lbs. for minutes
Installer Name (print)
Installer Signature Date 6�