HomeMy WebLinkAbout817 E ELIZABETH ST - SPECIAL INSPECTIONS - 5/24/2021Community 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 ~ \} E £\ i m \?v~ Permit No. \3 'Lot~ 3 55 Company Name l',;\Ort\il<-IM (b \ w <><;\o '0 VIM',;,,~~-_,,, Qty of Ft Collins Uc# \!IA Q -'S "r "I K Replacement of Sewer line approx. t O ft. (100 ft. maximum) _ Replacement of Water line _Add __ Replace gas line approx. ___ ft. (100 ft. maximum) approx. ___ ft. ( 50 ft. maximum) 4\\ s . Materials used: G\t\fcW.,.., \ 1-\.\:t?PE Tested at ______ Lbs. for ___ minutes Installer Name (print) K,1;:> d,\I\Lj \\vV\ v1c/½~ Installer Signature 64 v2~---"'\ Date 'j /z4 I 202 \