HomeMy WebLinkAbout620 PARK ST - SPECIAL INSPECTIONS - 9/4/2015I...' City of
Fart 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
Field Verification Form
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Job Site I Or7�1C g�L Permit No. :5 I SV 1,P S H'L
Company Name MQ . City of Ft Collins Lic# 1" `p'��I "I
Replacement of Sewer line approx. BO ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. J �" ft. ( 500 ft. maximum)
Materials used: k 3S SDg Sclnedole �l� Pk C �N ci
Tested at 1 (bs. for �s minutes
Installer Name (print) IF l►J O
Installer Signature �(,/' /pUC(i�j Date