HomeMy WebLinkAbout1205 GREEN ST - SPECIAL INSPECTIONS - 12/17/2021Cityof
ktColli~
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
Fiield Verification Form
Job Site _ _,_/_2_o5" __ G_:rre_!2A._--=st--=·--:;: __ f::0:-1--r:-::::---=-· _·_
City of Ft Collins Lie# /i1.1'7·9J'/
__ Replacement of Sewer line approx. ___ ft (100 ft. maximum)
__ Replacement of Water line approx. ___ ft. (100 ft. maximum)
£Add __ Replace gas line approx. ~ ft. ( 50 ft. maximum)
Materials used: _6(=?-ri
Tested at /0 lbs. for 3a minutes
Installer Name (print) _,,de""'-'-f..r:'efc......i.cf.L-zU,.,.,.,~,.,.,,\...;.=•t'J--'>c/..vr~----
lnstaller Signature. __ __,_,~-<=.s"r--,e_;":,"IJ7-d<.V"-=~-----UI Date _ __,_(_2-+--'-{_,7 /4._~-=p __
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