HomeMy WebLinkAbout912 MARBLE DR - SPECIAL INSPECTIONS - 8/22/2017Fort Collins
Community Development & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Pr >I155`Field Verification Form
Job Site,
Company Name No/4 w 6v(. plu r , n ' P [) ce r'J
Replacement of Sewer line
Replacement of Water line
Add Replace gas link
Materials used: / �"%(�l� I `%
Tested at
Permit No. d I bQ 9 77
City of Ft Collins Lic# 579
approx. ft. (100 ft. maximum)
approx. ft. (100 ft. maximum)
approx. ft. (50 ft. maximum) n
Lbs. for
Installer Name (print) ' ` k4g v, f 1
Installer Signatu 'Z14 4� z
minutes
Date