HomeMy WebLinkAbout806 MARSHALL ST - SPECIAL INSPECTIONS - 11/12/2020City of
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Job Site
Company Name Ne <+be r,J
Community Developm ent &. Nei ghbor hood Serv ices
281 N College Ave; P.O. Box 580; Fort Collins , CO 80522-0580
Phone : 970 221 6760 FAX : 970 224 6134
Field Verification Form
c·,. ) g'ot-, · a. 26/ · --g~-~ ( el'.'.'50"') A{ ~,snti I l Sf ,Permit No. 0 , 2 <; -•
(ole::c. 6b \:L.-.b ~, f D1~1 I\) City of Ft Collins Lie# .l.1P ,."5 7<1
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_ Replacement of Sewer line approx. -~_.ft . (100 ft. maximum) A Replacement of Water line approx. 0r ft. (100 ft. maximum)
_Add __ Replace gas line approx. ___ ft. ( 50 ft. maximum)
Materials used : ~'1 /I )L -Co~ R..
,AL h // Tested at r.: o\l pu&JaLbs. for .4:Wf I ;;, minutes
Installer Name (pr int) _____.12-o.........., .... Cc-i_~ .......... -"-'-'Y\ ..... ( ..... , .... c..a..h ..... $=..c.t ..... v::: __ _
Installer Signature_ ..... ~-'-'-'-"""L....._--=~'--C ___ --_---.....,.....__ __ _ Date__._} _,_,l {"---'. l-.....c'"Z.'-+--/ 7--+-f __