HomeMy WebLinkAbout443 W SWALLOW RD - SPECIAL INSPECTIONS - 3/15/2021Ci ty of
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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 ~~3 ~ ~a l~W f2d~CD&>52.4:i Permit No. Bk: /0 t:11.eS
Company Name_ J-t a re u;;;; ~1'~ f ~ ~ •:ia City of Ft Collins Lie# MP-1 -5
_ Replacement of Sewer line approx. ___ ft. (100 ft . maximum)
_ Replacement of Water line approx. ___ ft. (100 ft. maximum)
_ Add __ Replace gas line approx. ___ ft. ( 50 ft. maximum)
=ui.ftt.~J.!fd 2 ws3 c l-ec>nact • SD e, f i pe & s\5Wng ) Jn C '2-t~ C ~
Tested at · Lbs. for ___ minutes ()vq. '-
Installer Name (print) :11-Jad Tu l Vc:9ux;'
Installer Signature __ ,7L~L---'-'1_t'-c=-·/4'-"C:~'--=.S. _ _,d,~,....-,~~-~-=---Date_-=3_-_,s=--_2_,_I __