HomeMy WebLinkAbout4271 SOUTHSHORE CT - SPECIAL INSPECTIONS - 8/14/2020City of Community Development & Neighborhood Services
F6r} 83 N College Ave; P.O. Box 0 22 Fort Collins, CO 80522-0580
6134
V`I'1� Collinsv 1 1.7 Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site ' Ic)' ` ` �� t (411 i E-_D' Cl Permit No.-5a0o8 t 0'(9
Company Name G L�c�u� �� City of Ft Collins Lis# M P 3a
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. a ft. (100 ft. maximum)
_ Add Replace gas line approx. ft. ( 50 ft. maximum)
Materials used: V
Tested at '$s. for 0 minutes
Installer Name (print)
Installer Signature
Date L13 1 a'- ��0�7