HomeMy WebLinkAbout911 W 12th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date
Time
Received by
(phone, person)
Q II I) I Z~
Location of Work to be inspected 1- __ ~
Name of person requesting inspection ( rl' rt C {_~ '"
Address of person requesting inspection Phone No
",:yp~_of Inspection (circle appropriate one) Permit No
~oundation Framing Chimney Plumbing Final Sewer Excav Other
) / (7 )
. ,
INSPECTION NOTES
Inspected Date 7 r I rP - (;) (
Remarks
Time
4- 117
By ~ --< J ~
-- _.~
~ ~ 0 ~ r (e:te=..
RESTORATION REQUIRED
YES
NO :x
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'-o"tc 3/01
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
Cl Repaired by Permittee
CI No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)