HomeMy WebLinkAbout1215 W MOUNTAIN AVE - SPECIAL INSPECTIONS - 7/6/2021Community Development & Neighborhood Services 281 N College Ave; P.O. Bax S80; Fort Collins, CO 80522•0580 Phone; 970 221 6760 FAX: 970 :t24 6134 Field Verification Form JobSite /;/15 l,f ft2<UOf?uO Aveauif PemiitNo. f}£1D!f7u,2 Company Name M2r../:be:rn Oc:/l,catlv /JJL rm.b .. ac1 of j),. 1n1J City of Ft Collins Uc# iYIP O 7 1 , __ Replacement of Sewer line approx. ___ ft. (100 ft. maximum) ..)!:._ Replacement of Water line approx. '-v o ft. (100 ft. maximum) __ Add __ Repla~e gas fine approx. ft ( 50 ft. maximum) Matenals used: ___ ',~/4: \\ \l_-( C \2\:«---,. L 4'?n:·•~v·-x.__ 2-4-\-\cv ~~ Tested at v~--i--lV\{1' • Lb~ for --~..___mMWtes lnstaller Name (print) \-Z.~-c\.\.-~ b:t-v1 i\ C .,\l\.2,-e '::::-') Installer Signature h,W#"t./-'Z ~ ~ ./ Date f/1.,; J ?t 2 ) r I