HomeMy WebLinkAbout605 E PLUM ST - SPECIAL INSPECTIONS - 3/24/2015City of
Fort Collins
Community Development & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
/� ' q -Field Verification Form
Job Site �� F>� U�
Company Name //l,J�e���i
eplacement of Sewer line approx.'- n ft.
Replacement of Water line approx. Ej�_ ft.
Add
Materials used:
replace gas line
approx.
Tested at W PS; Lbs. for
Installer Name (print) G 3
Installer Signature
Permit N01-8n U
City of Ft Collins Lic#
(100 ft. maximum)
(100 ft. maximum)
ft. (50 ft. maximum)
utes
t� W Date I