HomeMy WebLinkAbout912 WHALERS WAY - SPECIAL INSPECTIONS - 5/21/2019City of I. Community Development & Neighborhood Services
Flirt Collins 281 N College Ave; P.O. Box 0 22 Fort Collins, : 9 80522-0580
6134
'+�I Phone: 970 221 6760 FAX: 970 224 6134
` Field Verification Form
Job Site I I )" UV-"Y F�CoIli'n5 , CO
Company Name Vef 4r,-;1 e � re / lacc sypd i
Permit No. 13 19 0 3 l 1 5-
City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
X Add r Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: 3,T + 3/41" bl r`Ck D-on 30 F-/-- C67—
Tested at
to Lbs. for f ® minutes
Installer Name (print) TV Occ
Installer Signaturey=---�—
Date `S/ a' / 1 1