HomeMy WebLinkAbout1362 /1430 W Lauridsen Blvd - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST '
Date J 1- '7 -- (:, .f
I~W 2S/J- /977
Time
Received by
(phone, person)
Location of Work to be inspected j :3 b J- f;. j '-I 3 D w JJ / tJ /-'>
Name of person requesting inspection /-LA...) i" C ~ j:.
Address of person requesting inspection / .,ti, -6- fj Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other LJ.....J c7\.....T--t,;--
INSPECTION NOTES
Inspected
Remarks
Date
lJu ,tJ1
Time
J6(-eIU-e{0
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By
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RESTORATION REQUIRED
YES
/'
NO L/
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC 0 Other
Wor~er # 117,
[]"COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)