HomeMy WebLinkAbout513 SKYLINE DR - SPECIAL INSPECTIONS - 7/26/2021City 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
JobSite B/3 StcylfrJ[, ]7;z_
Company Name A: LU;,\/ gen,v, cf
_.lf:: Replacement of Sewer line
__ Replacement of Water line
__ Add __ Replace gas line
Permit No. 13216 2729
City of Ft Collins Lie# J1f... l{
approx. S:o ft. (100 ft. maximum)
approx. ___ ft. (100 ft. maximum)
approx. ___ ft. ( 50 ft. maximum)
Materials used: _ _,lie..'_' ,_f..c..11.=c_i,_---"-f/_"_..c,..:.v,.fl.,"'"e'---'-''Nc:..._...,_fiAf.6,-"""--"'"'--t-Br,._,PG-"'----"'l.,_,!tvt;'--"'~---------
Tested at ______ Lbs. for minutes ----
Installer Name (print~ LPL~
Installer Signature,---,~~!f4'"'--'G--""""-'-'l~;.,--"""'::i:~.e::,,,:::,g_=----Date 7/zc,,lc:oz/
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