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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT . . . . . .
REQUEST
Date t(-- (p ~ of
Time ZoO PJt1.. Received by DeV4Vlt ~ E
(phone, person)
Location of Work to be inspected 0f?! ~c...rorl "'- S-t
Name of person requesting inspection L:\? Vl.vU-S E
Address of person requesting inspection ~r() Y,,--vd Phone No cf/7 -Lti?'f9
/
Type of Inspection (circle appropriate one) Permit No .
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav O~tLi0J
INSPECTION NOTES
Inspected Date L/ - f.c, - 0 L.(
Remarks t<12/Ja.f( hlow crff.
,
Time 50 D (Jv"1.
By Ve 11 Vt ( S E
RESTORATION REQUIRED
YES
NO ~
eJr f've 2Yzrf}u IctorttL 51-
C AlllCy )
2'-1gf
,~
....
~
~
\ll
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
CJ Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC 0 Other -rJr~[ ( c...re4,.
Work Order # I; gZ$l,- fCe,
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)