HomeMy WebLinkAbout4271 SOUTHSHORE CT - SPECIAL INSPECTIONS - 2/12/2021F6City of community-®evelopment &�,heighborhood',Services
rfs I dU1n,% 281 N College,Ave; P.O.. Box 580; Fort Collins, CO 80522?0580
Phone: -970 2216760 FAX: 970 ;224 6134
Meld Verification Form
.lob Site 4?l ( cowlm-0154eee
Permit No. $alM175C/
Company Name _ �1 j`'1tsa 6il1,.� �w4-t,"�, �c� City of Ft Collins Llc# M P S
____Replacement of Sewer Ilne approx. ft. (100-ft. maximum)
_ Replacement.of Waterline
—Add Replace gas line
Materials used: C
approx. ft. (100 ft.,maximum)
approx., Z7 ft. ( 50 ft. maximum)
Tested at l b~ Lbs. for V minutes
Installer Name (print
Installer Signature_ _ Date vZ jal an