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Home My WebLink About1503 W 10th St - Engineering c! f"ORT ~ 't~ n-a ....~ ~ ~C~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property zoning . . . Application valuation 04-00000766 Date .261162 1503 W 10TH ST 06-30-00-0-3-0677-0000- RES NEW SFR 9/21/04 RS7 RESDNTL SINGLE FAMILY 87525 Owner Contractor NORTH PENINSULA BUILDERS ASSOC P. O. BOX 748 PORT ANGELES (360) 452-8160 Structure Information Construction Type Occupancy Type Other struct info OWNER WA 98362 1945 SF SFR W/ATT795 SF GARAGE TYPE V NON-RATED SINGLE FAM & CONGREGATES TOTAL % LOT COVERAGE CONSTRUCTION TYPE NUMBER OF STORIES EXISTING LOT COVERAGE LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE NUMBER OF UNITS 30.00 V-N 1. 00 1. 00 10500.00 3150.00 3150.00 1. 00 Permit PUBLIC WORKS RES WATER SERV Additional desc Permit Fee 640.00 Plan Check Fee Issue Date 9/21/04 Valuation Expiration Date 3/21/05 .00 87525 Qty 1. 00 Unit Charge Per 640.0000 EA PW W/M 1" SERV 5/8" METER Extension 640.00 Permit Additional desc Permit Fee Issue Date Expiration Date RIGHT OF WAY 45.00 9/21/04 3/21/05 Plan Check Fee Valuation .00 87525 Qty 1. 00 Unit Charge Per 45.0000 ECH RIGHT OF WAY PERMIT Extension 45.00 permi t SANITARY SEWER HOOK UP Additional desc Permit Fee 95.00 Plan Check Fee Issue Date 9/21/04 valuation Expiration Date 3/21/05 .00 87525 Qty 1. 00 Unit Charge Per 95.0000 EA SAN SEWER HOOKUP Extension 95.00 Special Notes and Comments Building address sign shall not be less than 6" & not more than 12" in height. Numbers colors must contrast with wall color they are mounted on. (Ord. 14.36.050-E) 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 ction. ' Signature of Owner (if owner is builder) Date T:\PLANNINGIFORMSIlI02.15 [1111412003] BillLDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS 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 YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPD SEPARATE PERMIT: # ROUGH-IN I I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR W ALLlHOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONL Y) T-BAR INSULATION SLAB WALL / FLOOR / CEILING I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CmMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKlNGfLlGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYfUSE 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 FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNINGIFORMS\1102.15 [11/14/2003] S .,,,..~ 1!z -- ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 04-00000766 pin number . . .261162 Page Date 2 9/21/04 Special Notes and Comments When roof gutters are installed, drains will located in dry wells or piped to approved storm drain locations. Sidewalk to City standards required for school walking route. Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch. Building water line connection to water meter requires a Public Works inspection prior to back fill of ditch. Other Fees SEWER SYSTEM DELV CHARGE STATE SURCHARGE PW WATER SYSTEM USE FEE 745.00 4.50 1025.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 780.00 780.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1774.50 1774.50 .00 .00 Grand Total 2554.50 2554.50 .00 .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. Date Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) T:\PLANNINGIFORMS\II02.15 [11114/2003] BillLDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL 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 YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAJNAGEn>o~SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR W ALLIHOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONL Y) T-BAR INSULATION SLAB WALL! FLOOR / CEILING I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE! PELLET! CmMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKINGILIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE 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 FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNINGIFORMS\1102.15 [II114/2003] tJj >-l 'tl ;1>'000;1> 0'0 t"' ><: ; 'O;I>:;;Ot:l H:U '" '0 'O:UZZt:l >-l'" t:l --.. t"'0"'>-l:U ><:'0 (f) H tI:l::tl::tltI:l ;I> 0 0 >i Zt"' ;I>(f} O:U H ~. O(f} '"'" >-l t:l tlj tJj 0 '0 'tl "'. :U. 0 O:Ui'O :u :u'" 0'" >-l--" 3:0 N 'OCO ooZ H ~~ t"''''0 "''''0 '" "'(f} , :u 0 G)O >-l>-ltlj ow>-l w "'''' "''''c:: 00;1: t"'- t:lt:lH 0 , :;; '" e; 00'0 (f}H 00'" H N H ..." Z 0 :u Ii: '" 0 H >-l '" "'HG") "', Z ;1: '" (f}Z W(f) C:(f}'tl :u c: (f) W ~~~ ",ot"' >-l '" (f}",;I> ..., H Z...,tJj >-l ""C :;;OH t:ltJj :ut:ll ot"' ;l>C "'t'l (f}ot:l <H ~~~ ,"ot'l t'lt"' :u , :u t:l t"':Ucn (f) H >-lHH , Z (f}'Otl ;I> 0 G) --">-l~ (f) 0 OH (f) H 3: CD," 00 0 HZ 3: 00 3:ZH 0 Z(f} t'l ':'Si 3: ~ (f}'O Z t'l 'tlt'l >-l ot:l Z "'0 (f) "';I> >-l O>-l "'>-l (f) >-lH ~ H H 00 0 :UZ t:l Z '-<>-l Z t:l ;l>H 0 :u 'tl'tl(f) 3:0 >-l ;I> 5561 t'l~ t'l H (f}'" (f) Z ZZt:l >-l ;I> t'lt'lH t"' G) < t'l t"' H t'l W :u '" t"' 0 ><: '" '" N , CD H '" 0 t:l'tl ;1>;1> >-lG) t'lt'l '" --.. N CD --.. 0 "'''' BUILDING PERMIT INSPECTION RECORD Pe~r.-f -J1 ...p.~,--~ o L} -7(p(p CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL 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 YES NO FOUNDATION: FOOTINGS cq - /6 -C)'-j .J LL- WALLS C -2) -<::>4 ~Lt:- FOUNDATION DRAINAGElDOWN SPOUTS Ie -~(( .-I'} "'I ILl ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN PLUMBING numb. FIl'1CtI- ~/''3/0fi-J'''l A'fP' UNDER FLOOR 1 SLAB ROUGH-IN j .f" -DY J . L. WATER LINE (METER TO BLDG) ~... L-~ ULL.. GAS LINE BACK FLOW 1 WATER t AIR SEAL WALLS I!l. -I J-() ~ J" L, CEILING r I FRAMING JOISTS 1 GIRDERS I ..,...-. SHEAR W ALUHOLD DOWNS 121'1/()L 7LL WALLS 1 ROOF 1 CEILING I A. "'-I /J.1 d" J (1, DRYWALL {INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING l!:t -/ b -05- J.. J...,. I MECHANICAL ~evl.t . Pi t1A.1 &/r r; lor;,\] U/ Aft? HEAT PUMP GASLINE ' -t -n t{' \ I WOOD STOVE 1 PELLET 1 CIllMNEY - ,. HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT#'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT#'s SEPA: PARKINGILIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHTDEPT CONSTRUCTION R. W. 1 PWI CONSTRUCTION - R. W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 &/15106 ...:JW BUILDING T.\PLANNINGIFORMS\1 Hl2.15 [11/1412003] <:JPOIIT-\tiQ ,..-~.:!-~\. ,.~ .. -- ""<~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 01-- 7& 0 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property zoning . Application valuation 04-00000766 Date .261162 1503 W 10TH ST 06-30-00-0-3-0677-0000- RES NEW SFR 9/21/04 Owner Contractor /57)3 w ID~ I~PB4 RS7 RESDNTL SINGLE FAMILY 87525 NORTH PENINSULA BUILDERS P. O. BOX 748 PORT ANGELES (360) 452-8160 Structure Information Construction Type Occupancy Type Other struct info ASSOC OWNER WA 98362 1945 SF SFR W/ATT795 SF GARAGE TYPE V NON-RATED SINGLE FAM & CONGREGATES TOTAL % LOT COVERAGE CONSTRUCTION TYPE NUMBER OF STORIES EXISTING LOT COVERAGE LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE NUMBER OF UNITS 30.00 V-N 1. 00 1. 00 10500.00 3150.00 3150.00 1. 00 Permit PUBLIC WORKS RES WATER SERV Additional desc Permit Fee 640.00 Plan Check Fee .00 Issue Date 9/21/04 Valuation 87525 Expiration Date 3/21/05 Qty Unit Charge Per Extension __ _ _ _ _ _ _ =~ ~~ _ _ _ _ _ _ ~~~ ~~~~~ _~~ _ _ __ ~~_ ~~~ =" _ S~~~_ =~8" _ ~~=~~ _ _ _ _ _ _ _ ~ C640 :00 ~ 45.00 9/21/04 3/21/05 Plan Check Fee Valuation .00 87525 / 'J (/, r \ \ 0 tv ./ \0::' Permit Additional desc Permit Fee Issue Date Expiration Date RIGHT OF WAY Qty Unit Charge Per Extension ________=~~~_______~=~~~~~_~~~___~=~~=_~~_~~=_~~~~==_______________~45.0~ Permit SANITARY SEWER HOOK UP Additional desc Permit Fee 95.00 Plan Check Fee .00 Issue Date 9/21/04 Valuation 87525 Expiration Date 3/21/05 Qty Unit Charge Per E~tens' 1.00 95.0000 EA SAN SEWER HOOKUP 95.00- -----------------------------~~----------------------------------- -------- Special Notes and Corrunents . Building address sign shall not be less than 6" & not more than 12" in height. Numbers colors must contrast with wall color they are mounted on. (Ord. 14.36.050-El 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 Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\II02.15 [11/14/2003] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number . . . _ . 04-00000766 pin number . . .261162 Page Date 2 9/21/04 Special Notes and Comments When roof gutters are installed, drains will located in dry wells or piped to approved storm drain locations. Sidewalk to City standards required for school walking route. Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch. Building water line connection to water meter requires a Public Works inspection prior to back fill of ditch. -----~~~~~-;~~~--~-~-~-~-~-~-~-~-~--~~~~~-~~~;~~-;~~;-;~~~--~ STATE SURCHARGE ~. PW WATER SYSTEM USE FEE 25.00 Fee summary Charged Paid Credited ue ----------------- ---------- ---------- ---------- ---------- Perrni t Fee Total 780.00 780.00 .00 .00 plan Check Total .00 .00 .00 .00 Other Fee Total 1774.50 1774.50 .00 .00 Grand Total 2554.50 2554.50 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, ulilities, private and public improvemenls. This permit becomes null and void if work or construction authorized is not commenced wilhin 180 days, if construction or work is suspended or abandoned for a period of 180 days aflerthe work as commenced, or if required inspections have not been requested wilhin 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same 10 be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whelher 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 Ihe performance of construction. Signature of Contractor or Aulhorized Agent Date . Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\l1 02.15 (11/1412003) -' CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . REQUEST: / 1 ---- Date l'f (1 . b'v Time Received by I' F- (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. 04 -1 toy; Sewer Foundation Framing Chimney Plumbing (Final ~er Excav. Other SZ:u~ -- r' > (tc,J;r . 1 c:J O~ L,{)] f5~ N-PRA- INSPECTION NOTES: } Inspected: Date lP (7 tr~ Time 5;3DDIf,f. By RII Remarks: Dr-,'ve. uJo..'-I to /J /1-,</ ,. C("xO at Sc.u.{k. 2o.s t fPDp€'I'~1 Q.o>~).\.~1!- /'Jet- ('"c...~c f \ .:i:Je wa..\ -Ir /..A'i" b tGl be. <..0...... I.e;fed. (.J., 'fl... c:...",- a. I ? - 1""- " 'i.>~ uv Ie o......er-~ p....... 1" {"<e..A., =- . RE TORATION REQUiRED.,.... YES e1l\- 't w d k NO ,-fIt.- ~~~~o."'\ ~'bee," I - " --~ SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) "- " r--"; , ' , , " , " 9t.? -""",,- &t '<- __ \,---- c?J....--. " \ ,">- " \ '<. " \ " , " , " , , , " -',,/ , " " \ \ \ \ \ , I ___1-1"" 1""'- ~ i \ \ \ (fl ,.. " , , " "'-.', , , " " " " " , \ , \ \ , / / / / \ \ \ \ \ \ > / f :531 I I / I I / ! / I I (j ; f I I / f----....' \ \ , , , ' , ' " " "......." , " " ' , ' , ,- , , ; I I / , I / / I / I I / I I I I I I / I / ; "- ;f /1 ~I f / I / " / I I ~, / , , , , , ; , I f I f I I I I I I I I / / I /', I I , ; I I / " " A ,I ~ / ~j , I I I ~' ~ " , / / , I " "- , ......." '\./'->-;. \ I I I I / I / I / I I I' I / ,~ 1/ r~~ I;' , / I ", I I " , / / / / I I / I I I I / I I / I 1;1/6 1431 / I ( / / I I I / 75 Feel VerticlIl Datum -- NA vn 88 H,)riwntaf Datum ~ NAD 83191 N Area Map Hus map IS /10/ ill/endt:d 10 he 1I.I<<d m a {<<xul de."('nplloll- 7hl.\ map drm>illX /j produced by Ih" ell)' uf PorI Angde,-jor III m..III1Se alld P"'POWS ;:-- Am' olher I/se oflhlJ map drawml! shl/If /lul be Ihe rc;mm,\',h,htv of/he Or,' ., ., ... CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST: . Date I,) -I b --'6 l/ / Time /;;;- t/V i,/FVt. Received by , I (phone, person) Location of Work to be inspected /<)03 VI./ /0'1, Name of person requesting inspection {"J""tN ;::11/. Address of person requesting inspection 170-:> -<,p IS .,7 Phone No, (/17- </'0"/7 Type of Inspection (circle appropriate one): Permit No. o7'-7~c:;, Sewer Foundation Framing Chimney Plumbing Final Sewer Excav, Other (Yr:l f'€' / INSPECTION NOTES: Inspected: Date J CJ.16-oGj Remarks: yJRLJ Time I,); I/O tf'~ By I / J % /"u~.vr ,<)et/,.//>.p 7/7 c... 7//1 ~ O?OS'S',;),J' G , RESTORATION REQUIRED . . . . .. YES NO Y " f1/ ~V ;'f.' ... ~ J. I "'" f- 3' j' 1 -;"'G ~ /0 TA .\0 )?".~ ~?> Hsr SURFACE REST~ATION: SURFACE TYPE~ ~nimproved DGravel o Repaired by City o Repaired by Permittee o No Damage Found o Asphalt 0 PCC 0 Other Work Order # N705-~077 o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) . . . CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . INSPECTION REPORT. . . . . . . REQUEST: Date Z-/I ( c,. Time Received by 7rC.",';6 (phone. person) Location of Work to be inspected l SD",;, \0..1 l u.lf Name of person requesting inspection f", w ~ c:: & i (c.1t1?rc".. ~e-I("V\,\ 'A.{ 'vvIAJie.AJ\ I Address of person requesting inspection Phone No. .q 1"1- L'5~ 0 Type of Inspection (circle appropriate one): Permit No. 04 - 7 &y ~~0 Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: Inspected: Date z.. f l ( 0':; , Remarks: ~ \ ,.,....1 Time S PM By ~('-' RESTORATION REQUiRED...... YES NO - y 8" p"C- S ~ bel...... ,,!Vif\t::/''''..c..c ~ - "#'Irt lIfJJ q I CI) MI"j -07- t ~s~, t.rfl- Ct!" 'Plte. ~ \ <;,,!!. - tJ . 4' Puc l 150;' lIS ~/~ ~ :r. . ~~ SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 pcc o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE ~ (Continue on reverse side if necessary) STREET SUPERINTENDENT /DATEI