HomeMy WebLinkAbout4428 MONTE CARLO PL - SPECIAL INSPECTIONS - 3/10/2021City of
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Community Development & Neighborhood Services
2B1 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 ':i'iZ.~ ffil)!)7<: ea..-10 Y\w;.e.. Permit No. B2102040
Company Name e;c. :t.N I'._ Gm :E l}0'.)1lln ,';,;rv i<.e ('.,,,..f":"5) City of Ft Collins Lie# l'.:DP ·9fo'2.
__ Replacement of Sewer line
_)l_ Replacement of Water line
__ Add __ Replace gas line I
Materials used: ,o I .&3/'1 K C(J fl{lfj:r ,;
, ',:t)'
Tested at /1hf f(AJS5V(L(J(}Lbs.
approx. ___ fl. (100 fl. maximum)
a~prox. wo ft. (100 ft. maximumJ
approx. ___ fl. ( 50 ft. maximum)
30' fit I{ l-'!::ft,'tie
,, f
for /,$-minutes
Installer Name (print) __,._1)~"-"'CM...._.,,le-J-':'F'yi-"li-'-'-'Wl\'-'-'L'ir-,---:--n-,
Installer Slgnature. ___ -+·-+,,"#~--i'L;)~-r---Ht#'~~~---
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