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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT.
REQUEST
Date .I C .- ,7 <iJ- c <)
Time l / v /);11 Received by
;/7
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Location of Work to be inspected '6/.) F J.s r
Name of person requesting inspection L~ Itt. te' f rJ, ~ /
Address of person requesting inspection I 7 ()3 ,<; c) B <;, r Phone No Lj I 7- (('8"'1'/
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav ~~ /
INSPECTION NOTES
Inspected Date /0-) tt-os Time / / 'Jv AA-1 By 7/7
Remarks
I~A~ /'\ Se/vlc..<. -rr~..-r1 /?1t::i,--' 1-.. A.(;/fer
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RESTORA TION REQUIRED YES )( NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC ~ Other
Work Order # ':Jc::>s if ~ - 07 7
o COMPLETE
~INCOMPLETE
To;J - S'tn-/
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)