HomeMy WebLinkAbout1028 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
Job Site /02'3 ;fr.J((/JV/5 'il,1
Company Name ltulW ,>IY1?'1 c.G
Permit No. 17 Z /OZ (p; 2..
City of Ft Collins Lie# /,/'l-t/
't;;j. Replacement of Sewer line
__ Replacement of Water line
approx. 70 ft. (100 ft. maximum)
approx. ___ ft. (100 ft. maximum)
__ Add __ Replace gas line approx. ft. ( 50 ft. maximum)
, JII O II o 0 Materials used: "'I LVl, lf C,Uri6 1i<J rUrU i!f6 UNe-tL ,
Tested at ______ Lbs. for ____ minutes
Installer Name (print) --"J.it_.__.=~=:c.--<-f),=V.'-'"'/.'--'t-'l'---=~--"~---
lnstaller Signature~~
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Date 7./'Zl,, /zoz,,(