HomeMy WebLinkAbout1418 INDEPENDENCE RD - SPECIAL INSPECTIONS - 9/11/2015City of
ort 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
Job Site 44I� � a����t� k';� e—. Permit No.12� sail �T_
Company Name ( rY S—(ep eJ �—keeI Lj�yGe Films -/- City of Ft Collins Lic# T)�
Replacement of Sewer line approx. ft. (100 ft. maximum) I �%
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. -0_ ft. ( 50 ft. maximum)
Materials used: chz't.�
Tested at c Lbs. for �� minutes
Installer Nai
Installer Sig
ate 1(—C�