HomeMy WebLinkAbout2815 MERCY CT - SPECIAL INSPECTIONS - 4/8/2021City of
~Colli_!'.!:
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 dJf '5 11 C~t) C:f .
Company Name (11 kc __) f/rCJ f-i!.f 1) ~( v L c. ~
Permit No. (J ;Jjl Jtf?c:J-
City of Ft Collins Lie# //1/J ,2/ 5
__ Replacement of Sewer line
-J,L"'Replacement of Water line
__ Add __ Replace gas line
approx. ___ ft. (100 ft. maximum)
approx. 4b ft. (100 ft. maximum)
approx. ,ft. ( 50 ft. maximum)
Materials used: __ _,_f?r_ . ........,__7---_ _,P,~, f':_,,. .. _--c., ________________________ _
')
;', {_,) Tested at IC Lbs. --~----for
,') /,
~CZ'.~u __ minutes
Installer Name (print) __ --4-/1_/ h ...... z--'· =-----fc,__IJ_· 2._v_c..._l ____ _
Installer Signature ___ ~/}J'--~~ ..... · .......... ~-~-~----""---=----