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HomeMy WebLinkAbout912 BRAMBLEBUSH AVE - SPECIAL INSPECTIONS - 5/24/2021keort CoUins ~-Community Development & Neighborhood Services 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 {J; a &a.mhfc:: 6u~h /Ju£ Permit No. 6.,a /0 3.:Z 4 7 Company Name AkclJg,co &/ar&io Pft.dmb/oCj ~ l>r~city of Ft Collins Lie# IIJP-579 __ Replacement of Sewer line _¼_ Replacement of Wate(line approx. ___ ft. (100 ft. maximum) approx. ___ ft. (100 ft. maximum} . __ Add--;::; Replace g~~e . approx. --··-· ft. ( 50 ft. maximum) Matenals used: _ __,36}__, /.5:' C£t{;f-c.,.r __ ..._f1-_, ___ _ "" -1 " "lri /'ti v-" ---Tested at ~v-<f5J Lbs. for 0V-minutes lnslalle, Name (print) 112..~\L) ~rc),,LJ-J Q\, Installer Signature~~ t'{ 4~ . .....____ ... --~ oa,S /;;;_&4 (~£v/1C?-r) \. /4'e&47