HomeMy WebLinkAbout959 GILGALAD DR - SPECIAL INSPECTIONS - 5/20/2009r , ; Fort Collins Building & Zoning Department
} 281 N. College Ave. • P.O. Box 580 • Fort Collins, CO 80522-0580
Voice: 970-221-6760 • FAX: 970-224-6134
City of Fort Collins
Field Verification Form
Job Site 7 �r� / c a,/�-o{ ,(��%y Permit No. l30 � Q?-66,P
Company Name C(>j,-- �UkvN City of Ft. Collins Lic. # Mt)1- 6zZ
placement of Sewer Line
Replacement of Water Line
approx.
ft.
approx. L/ 0 ft.
Add _ Replace Gas Line approx.
Materials used: YO r - � 4-c-L" C' — co;a,
ft
(100 ft. maximum)
(100 ft. maximum)
( 50 ft. maximum)
Tested at 60 lbs. for y r- minutes
Installer Name (print) Pr
Installer Signature �� Date