HomeMy WebLinkAbout427 STONEY BROOK RD - SPECIAL INSPECTIONS - 9/20/2019City, Community Development & Neighborhood Services
For t Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
`I Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form G flLiqL4
Job Site J' /9ev C Permit No. I
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Company Name //�eX�' C /���io /�far� ' � City of Ft Collins Lic#
-Replacement of Sewer line approx. ft. (100 ft. maximum)
_ Replacement of Water line approx. ft. (100 ft. maximum)
4- Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: (&S Ve. Ra,
Tested at. Lbs. for minutes
Installer Name (print) //��r"
Installer Signature Z6 �,//%l� Date ?40