HomeMy WebLinkAbout3909 CENTURY DR - SPECIAL INSPECTIONS - 3/16/2021 I
Community Development & Neighborhood Services
'City Of 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Fort Collins
Field Verification Form
Permit No.
Job Site City of Ft Collins Lic#
Company Name
approx. ft. (100 ft. maximum)
_Replacement of Sewer line ft (100 ft. maximum)
�Zeplacement of Water line approx.
✓ft, (50 ft. maximum)
Add —
Replace gas line approx.
,
Materials used: f
� � minutes
Tested at Lbs. for
rint k�
Installer Name (p ) l b %
Date
Installer:Signature