HomeMy WebLinkAbout3939 CENTURY DR - SPECIAL INSPECTIONS - 3/16/2021 City of Community Development & Neighborhood Services
Fort Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site w�x& Permit No. 4 ao
Company Name il� City of Ft Collins Lic# t�17
Replacement of Sewer line. approx. ft. (100 ft. maximum)
Replacement of Water line approx. (100 ft. maximum)
Add Replace gas line approx. V eft. (50 ft. maximum)
Materials used: G
Tested at 66 Lbs. for minutes
Installer Name (print) !/C
Installer Signature /�22� Date Z /G/