HomeMy WebLinkAbout3851 CENTURY DR - SPECIAL INSPECTIONS - 3/16/2021 community Development & Neighborhood Services
city of 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Fort Collins Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Permit No.Ad dJ1711
Job Site City of Ft Collins Lic#
Company Name approx. ft. (100 ft. maximum)
Replacement of Sewer line ft. (100 ft. maximum)
approx.
placement of water line ft (50 ft. maximum)
Add Replace gas line approx.'
Materials used:
YJ
Tested at v
Lbs. for minutes
Tested
Installer Name (print)
Date
Installer Signature