HomeMy WebLinkAbout4425 STONEY CREEK DR - SPECIAL INSPECTIONS - 12/14/2017City of CollinsCommunity Development & Neighborhood Services
Fort lli281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
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Field Verification Form
Job Site `" W Y12 y-e c y kc Permit No. v 4i 0����
Company Name {', n cil f 1 to n 5 City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. �� ft. (100 ft. maximum)
Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: C "De Sc, !nn
Tested at
Lbs. for
Installer Name (print)�M✓1
Installer Signatur Ts
minutes
Date I2 /'