HomeMy WebLinkAbout4703 PRAIRIE VISTA DR - SPECIAL INSPECTIONS - 7/27/2015City of Community Development & Neighborhood Services
F6r't Colons 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
' Phone: 970 2216760 FAX: 970 224 6134
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�/ Field Verification Form R Cv��J
Job Site ] 7W p/L"i � e. VV. L�^� � Permit No. fl15,-iQa/-7
Company Name 6101-4 �lCtH�U%/ta City of Ft Collins Lic# AL Y13
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. 5-0 ft. ( 50 ft. maximum)
Materials used: �1G Sff 7�
Tested at /V Lbs. for 60 minutes
Installer Name (print) u ue �-1 rjo— �/ Dr �J
Installer Signature r CXN�� Date / 7 ��