HomeMy WebLinkAbout1004 MEADOWBROOK DR - SPECIAL INSPECTIONS - 6/3/2021City of ktColl~ 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 LI/Jt/ · AIMJ)'2W "/:kz¢k /)rl1VG-Permit No. 02/ OOL35 Company Name 4llthv' {6,Ji vr c6 City of Ft Collins Lie# ____ _ ~ Replacement of Sewer line approx. S'P ft. {100 ft. maximum) __ Replacement of Water Jine approx. ft. (100 ft. maximum) __ Add __ Replace gas line approx. ft. ( 50 ft maximum) Materials used: c,?P Y1rl llN'CfL 1 Pvi Tested at Lbs. for minutes Installer Name (prin~ =l:!?_~-I (I; . . Installer Signature_~-----~~.,....~.---.--.~--..,._--~-Date ~----~-~--