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Home My WebLink About1005 E 4th St - Building CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DiVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 BUILDING PERMIT ISSUED: 11/01/2002 PERMIT NO: 13033 OWNER/APPLICANT PROPERTY LOCATION 1005 4TH ST E BRAD & KATHY ANDERSON 1005 E 4TH STREET Lot: E 1/2 8-12 Port Angeles, WA 98362 Block: 4 [] Long Legal 360/000-0000 Subdivision: DOYLES T: S: Parcel No: 063000730420000 CONTRACTOR ARCHITECT FEELEY CONSTRUCTION N/A 2606 DEER PARK RD. Port Angeles, WA 98362 , 98360-0000 360/452-7559 360/000-0000 PROJECT INFO Project Value: $27,800.00 SFD Units: 0 Commercial: 0 Project Type: ADDN/REMODEL SFD SQ FT: 0 Industrial: 0 Occupancy Type: RESIDENTIAL Garage: 0 Occupancy Group: MFD Units: 0 Construction Type: MFD SQ FT: 0 Zoning Use: RS7 PROJECT NOTES 86.5 SQ. FT. ADDNT AND INT. REMODEL RECEIPT#9887 FEES ASSESSMENT Building Permit: 422.05 Misc Fee 1: $0.00 Plan Check: 168.82 Misc Fee 2: $0.00 State Surcharge: ;4.50 Misc Fee 3: $0.00 House Moving: ~0.00 Manufactured Home: ~0.00 Sign: ;0.00 TOTAL FEE: $668.12 Plumbing: ;42.00 AMOUNT PAID: $668.12 Mechanical: ;30.75 BALANCE DUE: $0.00 Radon: ;0.00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agbnt Date Signature of Owner (if owner is builder) Date T:~PL^N~ING\FO~JVJ$\] ]02.]5 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YESINO FOUNDATION: WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PEKM1T: # PLUMBING LrNDER FLOOR / SLAB ROUOH-IN i~_ ~.~0 ~ ,~ WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING /Z-lc) °02 ,/ ~t&?t DRYWALL T-BAR INSULATION SLAB WALL/FLOOR/CEILING /'~ ~/~O7_ MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIKE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 / J ~"~ ~(~'~ //~[~ ~ BUILDING T:\PLANNING\FOR.MS\1102.15 [4/2002] o~ ~,oat,~,_ FOR OFFICIAL USE ONLY: o~ Date R~c.:/i - l~ ~'~ BUILDING PERMIT - APPLICATION ~: Da~ App~vcd: The ~uildi~g Pe~it ~pplicatio~ m~t ~El~8 e~t Please ~e or print in in~ If you have any questions, please eaH 417~815 Applic~t or Agent: '(': &~[e-~ ~ ~S~ · ~ ~c Phone: ~ ~o - ~er: ~ : /~5~q ~ ~de~so~ Phone: Ad&ess: ~ovS C, ~ City:t~ ~V~tcS Zip: Mc~tec~n~ne~: Phone: Con~actor~:(;~c/~,/~(~s4 ~t ~. License g: :~/~Exp: ~--De-V5 Phone: Ad,ess: 2~¢ a~eep~.~lr ~ Ci~: ~7~ . Zip:. ~ LEG~ DESC~FTION: Lot: ~ ~ ~ - t ~ Block: Sub~v~ion: ~L~ CO~Y P~CEL ~BER: Credit Card Holder Na~: Biffing ~ddr~: CiW:. Credit Card g: Exp. Date: ~SA MC ~E OF WO~: SI~UA~ON: ~ R~id~l ~ew Com~. ~ Re-r~f ~ Wood-stove ~, ~ SF. ~ $~ /SF. =$ ~ Mulfi-f~ly ~ Addition D Move D G~age SF. ~ $. /SF. = $ ~ Co~e~cial ~ Rem~el ~ Demolihon ~ Deck SF. ~ $. /SF. = ~ ~ R~ - m Sign ~ TOTAL VALUATION $ ~ ~ ' B~F DESC~TION OF ~ PRO,CT: %~ ~ ~ '; 6- ~ ~ ~ ~g ~ COM~RC~SIDEN~: Occup~cy Group: . Occup~t Load: ~ Com~cfion T~: No. ofStodes: [ ~tS~e: ~O~ %~tCoverage: /q,Z ~ . Em~g Lot Coverage: / Z ~& /sq. ~ + Proposed L~otC0verage: ~,~ /sq. fl. =TOTALLOTCOVE~GE: PLANING USE O~Y: ~PROV~S: PL~ Not~: BL~. DPW ES~etl~d{s): ~ Yes ~ No SEPA ~ec~t requked? ~ Yes ~ No O~er: O~R B~DING PE~ ~P~CA~ON S~: Your ~pl~on ~d s~e pt~ mu~ betided out co~pl~ely to be accepted for r~m. The B~g Dillon c~ prohde you wi& more detailed ~fomtion on ~e a~licafion ~d p~ sub~l requke~n~. Yo~ co~leted applicafio~ site pl~ (for addition) and bml~g cons~cfion pla~ ate to be sub,Red to &e B~d~g Division. V~UATION OF CONS~UC~ON: In all eases, a valuation amount must be entered by ~e a~lic~t. ~s fi~e ~11 be ~vie~d and my be rev~ by ~e B~ld~g Div~ion to co~ly M~ c~ent fee schedules. Contact ~e Pe~t Coordmtor at 4174815 for ~sis~nce. PL~ C~CK FEE: Yo~ pl~ check fee is due at ~e time ~e bml&ng pe~t a~licafion and co~ction pla~ are sub,Red. All o~ pe~t fees are due at ~e time ofpe~t issuance. EXP~TION OF PL~ ~W: If no p~t is issued ~ 180 days of~e date of a~licafion, tbs application will expire. Buil~g Offici~ can extend ~e ~e for action by ~e applic~t up to 180 days upon ~en ~quest by ~e applic~t (see Section 107.4 of · e Unifo~ Building Code, c~ent edition). No application c~ be extended more ~ once. I hereby cert~ that I have read and examined th~ applica~on and ~ow the same to be ~e and co~ect, and I am authorized to apply for this pe~it. 1 understand it ~ not the Ci~ legal respo~ibili~ to determine what pe~i~ are required: it remains the applicant's responsibili~ to dete~ine what pe~i~ are required and to obtain such. Applicon:/. ~ ~ Date: / ~ : SITE PLAN DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION APPLICANT: PROJECT/DEVELOPMENTADDRESS: /~ 5-'" ~ ~ ~ /~ fl~, ~ See Page 4 for instructions on completing the site plan. For more information, ca11417-4815. ,, CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date/,~'' /'~ ~ '~ Time Received by (phone, person) Location of Work to be inspected Address of person requesting inspection_ Phone No. _ Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NO~TES:, Inspected: Date Time By Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved ~]Gravel []Asphalt E}PCC []Other [-I Repaired by City Work Order # ~] Repaired by Permittee [-~ COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary} STREET SUPERINTENDENT (DATE~ CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Datel v £P'~ Time ./~/ ~? Received by~(phone, person) Location of Work to be inspected ! ~)C)~ ~_'- ~L/jT-l~ ~'~ Name of person requesting inspection ~ ~ ~ ~ ~ ~ ,~ Address of person requesting inspection Phone No..~ ~ ~ Type of Inspection (circle appropriate one): ..... ~ Permit No. / ~ Sewer Foundat on Fram,ng Chimne~umb!ng~F na Sewer Excav. Other , ~, Inspected: Date / ~ ~--D ~ Time By ~ Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [-]Gravel [~Asphalt [~]PCC [~Other [] Repaired by City Work Order # El Repaired by Permittee ['~ COMPLETE [] No Damage Found [] INCOMPLETE {Continue on reverse side if necessary) STREET SUPERINTENDENT {DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT .... Date _ ~'"_'~ ~-'~ '~'' Time Received b phone, person) Location of Work ,o be ,nspected /~) (~) ~''~ ~'~ Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circ~ iate one): Permit No. / Sewer Foundation~r:himney Plumbing Final Sewer Excav. Other ~~ INSPECTION NOTES: Inspected: Date ~ ~ ' ~ ~- Time By Remarks: ~..~-..~ ,. RESTORATION REQUIRED ...... YES. NO. SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [~Gravel [~Asphalt []PCC []Other . [] Repaired by City Work Order # I--] Repaired by Permittee [~ COMPLETE [] No Damage Found [] INCOMPLETE {Continue on reverse side if necessary} STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: ~ _Time Received by (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sbwer Excav. Other INSPECTION NOTES: Inspected: Date / - ~ · ~ .-..~' Time By Remarks: RESTORATION REQUIRED ...... YES NO. SURFACE RESTORATION: SURFACE TYPE: [] Unimproved []Gravel []Asphalt [~PCC I~Other I--] Repaired by City Work Order # [] Repaired by Permittee [] COMPLETE ~-INo Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DiVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 BUILDING PERMIT ISSUED: 11/01/2002 PERMIT NO: 13033 OWNER/APPLICANT PROPERTY LOCATION 1005 4TH ST E BRAD & KATHY ANDERSON 1005 E 4TH STREET Lot: E 1/2 8-12 Port Angeles, WA 98362 Block: 4 [] Long Legal 360/000-0000 Subdivision: DOYLES T: S: Parcel No: 063000730420000 CONTRACTOR ARCHITECT FEELEY CONSTRUCTION N/A 2606 DEER PARK RD. Port Angeles, WA 98362 , 98360-0000 360/452-7559 360/000-0000 PROJECT INFO Project Value: $27,800.00 SFD Units: 0 Commercial: 0 Project Type: ADDN/REMODEL SFD SQ FT: 0 Industrial: 0 Occupancy Type: RESIDENTIAL Garage: 0 Occupancy Group: MFD Units: 0 Construction Type: MFD SQ FT: 0 Zoning Use: RS7 PROJECT NOTES 86.5 SQ. FT. ADDNT AND INT. REMODEL RECEIPT#9887 FEES ASSESSMENT Building Permit: 422.05 Misc Fee 1: $0.00 Plan Check: 168.82 Misc Fee 2: $0.00 State Surcharge: ;4.50 Misc Fee 3: $0.00 House Moving: ~0.00 Manufactured Home: ~0.00 Sign: ;0.00 TOTAL FEE: $668.12 Plumbing: ;42.00 AMOUNT PAID: $668.12 Mechanical: ;30.75 BALANCE DUE: $0.00 Radon: ;0.00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agbnt Date Signature of Owner (if owner is builder) Date T:~PL^N~ING\FO~JVJ$\] ]02.]5 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YESINO FOUNDATION: WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PEKM1T: # PLUMBING LrNDER FLOOR / SLAB ROUOH-IN i~_ ~.~0 ~ ,~ WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING /Z-lc) °02 ,/ ~t&?t DRYWALL T-BAR INSULATION SLAB WALL/FLOOR/CEILING /'~ ~/~O7_ MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIKE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 / J ~"~ ~(~'~ //~[~ ~ BUILDING T:\PLANNING\FOR.MS\1102.15 [4/2002] o~ ~,oat,~,_ FOR OFFICIAL USE ONLY: o~ Date R~c.:/i - l~ ~'~ BUILDING PERMIT - APPLICATION ~: Da~ App~vcd: The ~uildi~g Pe~it ~pplicatio~ m~t ~El~8 e~t Please ~e or print in in~ If you have any questions, please eaH 417~815 Applic~t or Agent: '(': &~[e-~ ~ ~S~ · ~ ~c Phone: ~ ~o - ~er: ~ : /~5~q ~ ~de~so~ Phone: Ad&ess: ~ovS C, ~ City:t~ ~V~tcS Zip: Mc~tec~n~ne~: Phone: Con~actor~:(;~c/~,/~(~s4 ~t ~. License g: :~/~Exp: ~--De-V5 Phone: Ad,ess: 2~¢ a~eep~.~lr ~ Ci~: ~7~ . Zip:. ~ LEG~ DESC~FTION: Lot: ~ ~ ~ - t ~ Block: Sub~v~ion: ~L~ CO~Y P~CEL ~BER: Credit Card Holder Na~: Biffing ~ddr~: CiW:. Credit Card g: Exp. Date: ~SA MC ~E OF WO~: SI~UA~ON: ~ R~id~l ~ew Com~. ~ Re-r~f ~ Wood-stove ~, ~ SF. ~ $~ /SF. =$ ~ Mulfi-f~ly ~ Addition D Move D G~age SF. ~ $. /SF. = $ ~ Co~e~cial ~ Rem~el ~ Demolihon ~ Deck SF. ~ $. /SF. = ~ ~ R~ - m Sign ~ TOTAL VALUATION $ ~ ~ ' B~F DESC~TION OF ~ PRO,CT: %~ ~ ~ '; 6- ~ ~ ~ ~g ~ COM~RC~SIDEN~: Occup~cy Group: . Occup~t Load: ~ Com~cfion T~: No. ofStodes: [ ~tS~e: ~O~ %~tCoverage: /q,Z ~ . Em~g Lot Coverage: / Z ~& /sq. ~ + Proposed L~otC0verage: ~,~ /sq. fl. =TOTALLOTCOVE~GE: PLANING USE O~Y: ~PROV~S: PL~ Not~: BL~. DPW ES~etl~d{s): ~ Yes ~ No SEPA ~ec~t requked? ~ Yes ~ No O~er: O~R B~DING PE~ ~P~CA~ON S~: Your ~pl~on ~d s~e pt~ mu~ betided out co~pl~ely to be accepted for r~m. The B~g Dillon c~ prohde you wi& more detailed ~fomtion on ~e a~licafion ~d p~ sub~l requke~n~. Yo~ co~leted applicafio~ site pl~ (for addition) and bml~g cons~cfion pla~ ate to be sub,Red to &e B~d~g Division. V~UATION OF CONS~UC~ON: In all eases, a valuation amount must be entered by ~e a~lic~t. ~s fi~e ~11 be ~vie~d and my be rev~ by ~e B~ld~g Div~ion to co~ly M~ c~ent fee schedules. Contact ~e Pe~t Coordmtor at 4174815 for ~sis~nce. PL~ C~CK FEE: Yo~ pl~ check fee is due at ~e time ~e bml&ng pe~t a~licafion and co~ction pla~ are sub,Red. All o~ pe~t fees are due at ~e time ofpe~t issuance. EXP~TION OF PL~ ~W: If no p~t is issued ~ 180 days of~e date of a~licafion, tbs application will expire. Buil~g Offici~ can extend ~e ~e for action by ~e applic~t up to 180 days upon ~en ~quest by ~e applic~t (see Section 107.4 of · e Unifo~ Building Code, c~ent edition). No application c~ be extended more ~ once. I hereby cert~ that I have read and examined th~ applica~on and ~ow the same to be ~e and co~ect, and I am authorized to apply for this pe~it. 1 understand it ~ not the Ci~ legal respo~ibili~ to determine what pe~i~ are required: it remains the applicant's responsibili~ to dete~ine what pe~i~ are required and to obtain such. Applicon:/. ~ ~ Date: / ~ : SITE PLAN DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION APPLICANT: PROJECT/DEVELOPMENTADDRESS: /~ 5-'" ~ ~ ~ /~ fl~, ~ See Page 4 for instructions on completing the site plan. For more information, ca11417-4815. ,, CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date/,~'' /'~ ~ '~ Time Received by (phone, person) Location of Work to be inspected Address of person requesting inspection_ Phone No. _ Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NO~TES:, Inspected: Date Time By Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved ~]Gravel []Asphalt E}PCC []Other [-I Repaired by City Work Order # ~] Repaired by Permittee [-~ COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary} STREET SUPERINTENDENT (DATE~ CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Datel v £P'~ Time ./~/ ~? Received by~(phone, person) Location of Work to be inspected ! ~)C)~ ~_'- ~L/jT-l~ ~'~ Name of person requesting inspection ~ ~ ~ ~ ~ ~ ,~ Address of person requesting inspection Phone No..~ ~ ~ Type of Inspection (circle appropriate one): ..... ~ Permit No. / ~ Sewer Foundat on Fram,ng Chimne~umb!ng~F na Sewer Excav. Other , ~, Inspected: Date / ~ ~--D ~ Time By ~ Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [-]Gravel [~Asphalt [~]PCC [~Other [] Repaired by City Work Order # El Repaired by Permittee ['~ COMPLETE [] No Damage Found [] INCOMPLETE {Continue on reverse side if necessary) STREET SUPERINTENDENT {DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT .... Date _ ~'"_'~ ~-'~ '~'' Time Received b phone, person) Location of Work ,o be ,nspected /~) (~) ~''~ ~'~ Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circ~ iate one): Permit No. / Sewer Foundation~r:himney Plumbing Final Sewer Excav. Other ~~ INSPECTION NOTES: Inspected: Date ~ ~ ' ~ ~- Time By Remarks: ~..~-..~ ,. RESTORATION REQUIRED ...... YES. NO. SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [~Gravel [~Asphalt []PCC []Other . [] Repaired by City Work Order # I--] Repaired by Permittee [~ COMPLETE [] No Damage Found [] INCOMPLETE {Continue on reverse side if necessary} STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: ~ _Time Received by (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sbwer Excav. Other INSPECTION NOTES: Inspected: Date / - ~ · ~ .-..~' Time By Remarks: RESTORATION REQUIRED ...... YES NO. SURFACE RESTORATION: SURFACE TYPE: [] Unimproved []Gravel []Asphalt [~PCC I~Other I--] Repaired by City Work Order # [] Repaired by Permittee [] COMPLETE ~-INo Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)