HomeMy WebLinkAbout3932 CENTURY DR - SPECIAL INSPECTIONS - 3/16/2021 CItyOf Community Development
Neighborhood
bnhFort Collins 28 NColege e P.O. Bo 80• Fort Collins, 80522 0580
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form .grid 12�
Job Site �� 6) Permit No.
Company Name City of Ft Collins Lic# OCbLt�
�106)1te
i/Re
Replacement of Sewer line approx. ft. (100 ft. maximum)
placement of Water line approx. ft. (100 ft. maximum)
Add eplace gas line approx. rt/ ,ft. (50 ft. maximum)
Materials used: r
Tested at Lbs. for minutes
Installer Name (print) l�r(�,
Installer Signature -�� "�` DateJ✓�1.�✓