HomeMy WebLinkAbout4306 BEAVER CREEK DR - SPECIAL INSPECTIONS - 11/6/20151�City of I I . Community Development & Neighborhood Services
Flirt Collins 281 N College Ave; P.O. Box 0 22 Fort Collins, CO 80522-0580
6134
'+�_ Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site 430c.-:, —8�er-Lte,'—K- 72• !�!,- CbLuvtS Co Permit No. B 150-79%0
Company Name nW l e-?LjA Nf.F' City of Ft Collins Lic# MP-- 9q-7
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. -5b ft. (100 ft. maximum)
Add Replace gas line approx. ft. (50 ft. maximum)
Materials used: �12S8o f7e X _
Tested at 1�0 Ljb�s. for 30 minutes
cJ Installer Name (print) PY21U1.1 ceutz-or
Installer Signature J&Date