HomeMy WebLinkAbout621 WOOD ST - SPECIAL INSPECTIONS - 8/30/2014Fort 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 Foxt Collins
Field Verification Form
Job Site UZA Wcx4� -:�ipc Permit No. :?2 115c:>j,��
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Company Name _ EUl✓ W jb/1—Cn City of Ft. Collins Lic. # _ vAp oo i OO-14d
Replacement of Sewer Line
Replacement of Water Line
v Add _Replace Gas Line
approx.
approx.
approx.
(100 ft. maximum)
(100 ft. maximum)
( 50 ft. maximum)
Materials used: 14 'uhu- s-rciru -nw-e ev pipe
3/,{. G55'( TohC PWE , ?l (—r,-➢6;S
Tested at I5 lbs. for 6u minutes
Installer Name (print) pVc- L,061\-Co
Installer Signature Date 8 / 30 //j