HomeMy WebLinkAbout1112 E 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
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Date I -,-0 5
Time
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Location of Work to be inspected II ( l E' 5-1!:;-
Name of person requesting inspection j)e-I-1.Vf.',5 ~
Address of person requesting inspection (0 r vJ ';{ r J {7 c:::I.-- 6 Phone No 'I ( 7- '-( ?if '1
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Type of Inspection (circle appropriate one) Permit No
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Oth~ UC-L TJ
INSPECTION NOTES
Inspected
Remarks
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Date 7- ";:/ --0 5 Time
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Received by ?>C'n f'l., 5 E...
(phone, person)
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RESTORATION REQUIRED .
. YES
NO X
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt 0 PCC
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D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Other
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)