HomeMy WebLinkAbout3903 CENTURY DR - SPECIAL INSPECTIONS - 3/16/2021 ment &Neighborhood Services
Community Develop CO 80522-0580
281
City of N College Ave; P.O. Box 580; Fort Collins,
Phone: 970 221 6760 FAX: 970 224 6134
Fort Collins
Field Verification Form I f�
Permit No.
J6 � I
Job Site City of Ft Collins Lic# f
Company Name
approx. ft. (100 ft. maximum)
_Replacement of Sewer line approx.
(100 ft. maximum)
�2eplacement of Water line approx. (50 ft. maximum) .
Add Replace gas line approx. —.
Materials used: -- —minutes
Lbs. for d
Tested at J
Installer Name (print)
Date
Installer'.Signature