HomeMy WebLinkAbout813 LOWE ST - SPECIAL INSPECTIONS - 5/24/2010�� Fort Collins Building & Zoning Department
281 N College Ave PO Box 580 Fort Collins CO 80522-0580
I Voice 970 2216760 FAX 970 224 6134
CAV of Fort Colhns
Field Verification Form
Job Site a0/3 of c t1�� XC Permit No
Company Name h/% c 52dty of Ft Collins Lic #
Replacement of Sewer Line approx ft (100 ft maximum)
Fcement of Water Line approx ft (100 ft maximum)
Pdd _ Replace Gas Line approx ft ( 50 ft maximum)
Materials used ALL
Tested at 2O Ibs for
Installer Name (print)
Installer Signature
minutes
Cate