FTTP-CR051011 Oct 11 05 01 : 53p p. 1
Page -I of 4
7 H G I 7 Y O F
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UTILITY RELOCATION IN RIGHT-OF-WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
- -
Contact City of Coppell Public Works Division at 972-462-5155 to schedule an inspection
with Utility & Streets personnel to verify that your project has been completed to City of
Coppell specifications. Failure to schedule verification inspection may delay future projects.
Franchise Utility Name f ,,G� 5'/1/ E i b A 5
l
Project Location / Applicant's WorkOrder # of applicable,3PZ)/f//
/ ( rif&'6jZ (1,0545/wr/ / //�'fL f40/6 z4
Sub-contractor Company Name ,e/#'
24 hr.Contact Number � - 'D• 6 /3 L
Date of Verification Appointment /40//b
Time of Verification Appointment `J. 6 4 /12..
INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELI,PERSONNEL
-:• Inspected by 'Nix€5//.t! (0cbof Utilities Maintenance Division on /0—.I/ ,
and found to b. acceptable e
Follow-up needed?'NO YES Follow-up scheduled for
•:• Inspected by of Streets Maintenance Division on
and found to be acceptable /not acceptable because
•
•
Follow-up needed? NO/ YES Follow-up scheduled for
•
A copy of this completed notice is to be provided to:
City of Coppell Engineering Dept.
255 Parkway Blvd., Coppell TX 75019
Office: 972-304-3679 Fax: 972-304-3570 •
Oct 11 05 01 : 53p p. 2
STATEMENT 29680
TO DATE
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TERMS
IN ACCOUNT WITH
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