HomeMy WebLinkAbout3921 CENTURY DR - SPECIAL INSPECTIONS - 3/16/2021 Cltyof 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 I-f g1 ZmAII, a-, Permit No.13 o zy o V ,<
Company Name �`?2� City of Ft Collins Lic# G�/�1,0
Replacement of Sewer line approx. ft. (100 ft. maximum)
��eplacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. ��ft. (50 ft. maximum)
Materials used:
Tested at T U Lbs. for ��' minutes
Installer Name (print)
Installer Signature %�L��'�U J c ""`�` Date