HomeMy WebLinkAbout743 MARIGOLD LN - SPECIAL INSPECTIONS - 11/26/2021Ci ty of
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Community Oeveloprnent & Neighbothood Services
281 N Coilege Ave; P.O . Box 580; Fort Collins, CO 80522 --0580
Phone; 970 221 6760 FAX ; 970 224 6134
Field Verification Form
Job Site 1.J C: l'O C cl O d () m/ 7'1 ':> Mt., : ? dd IA 'V Pe,mll No 8, . 2 0 ~2 5 8 le,
Company Name )J C-! vN, C U Co l ,H Ct d l > l~t rah :,......._ -f D f,:; (f\..) Clty of Ft Collins Lie# .N P·· S 7 0 . -. ~)
___ Replacement of Sewer line approx._ . ft. (100 ft . maximum)
)!!:_ Replacement of Water line approx . -? D ft (1 00 ft . maximum)
__ Add __ Replace gas line approx. ___ ft. ( 50 ft. maximum)
Materials used: 1/..., \L._ ..-C Oq>p-el@...
Tested at _bLJl frL";L?.{u lbs. for 2 4 t\ (}. ~inutes
I nstaller Name (print) ~ d H 11Q c b <;.,.e t\,)
Installe r Signature _ _,,,/2~ ... ✓"""·_,,_, ~f'--::::::::1..d __ ....... =--'-------Da~ __ )l _,_~_,_
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