HomeMy WebLinkAbout650 SMITH ST - SPECIAL INSPECTIONS - 6/2/2019City of Community Development & Neighborhood Services
Fort Collins"281 N College Ave;P.O. Box 580; Fort Phone: 9702 Collins,
21 6 60FAX 970 224 6134
Field Verification Form
Job Site (eSG 5rrn ;A 22:^^ F4 . C& I 1%h5 Permit No. $ �qo ( �Co7'
Company Name �&JA4,tra,y C6!/- ACj0 .p&Mbjn,i b(,,r/V City of Ft Collins Lic# /t R —S-;q
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas link approx. ft. ( 50 ft. maximum)
Materials used: SA-�dujQ V-"D P O,
Tested at 00Lbs. for 2YhrzS_ minutes
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Installer Name (print) R� #eh r,Lh
Installer Signature Y /W�T_
Date (p�