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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT.
REQUEST
Date S-' J..) -C' )-
Time /:2, cn.) ~J1 Received by
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(PhOn~
Location of Work to be inspected 7 / ,) E. .;2 /1J
Name of person requesting inspection eJt1t..Te / 0,(/,
Address of person requesting inspection J7e-"'':?' S~ {? '5'/ Phone No 9/7, c../~Y7
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav ~ {... a TC' ,.r
INSPECTION NOTES
Inspected Date S--t/- <;- -05-
Remarks
Time )?; 5(.-' I'd-'\. By
7/1
~~I:: ,e 'AI,~~ c:! lA/ II~ J
RESTORA TION REQUIRED . . . . YES Y NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC ~ Other j 0/ - 50 c /
Work Order # 'J 0 J Yb - C?Y6
o COMPLETE
)2KINCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)