HomeMy WebLinkAbout607 WARREN LNDG - SPECIAL INSPECTIONS - 7/19/2019City of I Community Development & Neighborhood Services
Fort Collins 281 N College Ave; P.O. Box 0 22 Fort Collins, CO 80S22-0580
6134
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
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Job Site �C� o �-l/��!'�*` `-u'�^o` a Permit /y 'T / �0
Company Name City of Ft Collins Lic# &3
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line
Add Replace gas line
Materials used:
approx. ft. (100 ft. maximum)
approx. 10 ft. ( 50 ft. maximum)
Tested at ty Lbs. for Zy minutes
Installer Name (print) . 'P- C 1 . 2-
Installer Signature
Date �711 � // �