HomeMy WebLinkAbout1631 KIRKWOOD DR - SPECIAL INSPECTIONS - 5/25/2021C1tyof _fort Collins --~ Community Development & Neighborhood Services 281 N College Ave; P.O. Box 580; Fort Collins, co 80522-0580 Phone: 970 221 6760 FAX: 970 ~4 6134 Field Verification Form Job Site lit,-dl &ri!..u::r:at ,/)£///!£ Company Name lt)orlt}C-C(J Cohrw~2 /JI urYJbioq ~ JJra:n Permit No .... l) Js /0 1::/.(12q(e City of Ft Collins Lie# _{[)_ P ·5 ?/<1 __ Replacement of Sewer line .£_ Replacement of Water line __ Add __ Replace gas line approx. ___ ft. (100 ft. maximum) approx. w':2 ft. (100 ft. maximum) approx. ___ fl. ( 50 ft. maximum) Materials used: 5/4 ., \(. -Co ~ft1r T · \_ -2j 'r-c'-'-<'> ested at .\.,\_p \'\'.,A~:( ..uis._ for fl'linuloe y.?t-c;..)S\,""°U Installer Name (print) \2.cc:\n:t:j \1lV}1 c.,\ \.)).t ~ Installer Signature ~4~~ Date .:T {i...o 1)-0?J\ t Ka&-r I I") c::: ,f,/c.£1.1 ee/V '