HomeMy WebLinkAbout630 SMITH ST - SPECIAL INSPECTIONS - 6/12/2017City of Community Development & Neighborhood Services
Fnr't Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
/�,�`■- Phone: 970 221 6760 FAX: 970 224 6134
3OW111e1 G-IS --/7 9w0k
Field Verification Form
Job Site (O 30 di4,ZT/./ Permit No. 70n e77
Company Name �'C/�Cn//1 ��uM67,c�(r �GT7oa�S City of Ft Collins Lic# - 6
Replacement of Sewer line approx. ft (100 ft. maximum)
Replacement of Water line approx. ft (100 ft. maximum)
Add Replace gas line approx 20 ft. ( 50 ft. maximum)
Matenals used: 1 4ick zmgz A&
Tested at /0 Lbs. for tfhR-s minutes
Installer Name (print) A�i7�
Installer Signature Date �0:?