HomeMy WebLinkAbout4809 CHIPPENDALE DR - SPECIAL INSPECTIONS - 6/13/2005Fort Collins Building & Zoning Department
281 N. College Ave. P.O. Box 580 • Fort Collins, CO 80522-0580
fim Voice. 970-221-6760 - FAX: 970-224-6134
Cityof Post Collins
Field Verification Form
Job Site 4 1Or 07 d4erl a Permit No. 6(2 q&'7� 179
Company Name A I Y Cam City of Ft. Collins Lic. #
Replacement of Sewer Line approx.
Replacement of Water Line
Add i Replace Gas Line
Materials used:
approx.
ft.
ft.
approx. ft.
(100 ft. maximum)
(100 ft. maximum)
( 50 ft. maximum)
Tested at ;� Q' lbs. for yZ . _ minutes
Installer Name (print)
Installer Signature
Date & — 13 — a,5-*�
TO 39Cd HaW LSOZ99ZOL6 LT:£T S00Z/£T/90