HomeMy WebLinkAbout505 E 10th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:
Date I J- ~ -0) Time /0 ;(rU 11,n Received by / (7 (PhOne,~o~
Location of Work to be inspected 5-05 C/O 7 t.....
Name of person requesting inspection (A/Ci.fe r ;:/: t/
Address of person requesting inspection ; 7 0 ~ 50 l? '5 T Phone No If/7 - t.(ff'/1'
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav ~ ~.e:(. t c /
INSPECTION NOTES:
Inspected Date I (). - <) -Os-
Remarks
Time / " uV .t? ,Yl
I
By 7 17
f) ~...
~ ,nCi,FYt
b/€c,
f-e;;J~iI~d &VII/I..
,
55' /e~,/ b&:iI'HI
,
RESTORATION REQUIRED . . . . .. YES Y NO
'\t \ 1
'1
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.... ......
~~c....e. ... - ~ ';'" t:.T
{.... ~ 9" ---1
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\j I 0 Tt...
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'S
:t (..f .- - ;J. \' c.i:
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SURFACE RESTORATION:
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
o Repaired by Permittee
o No Damage Found
D Asphalt D PCC PQ' Other [~; 'Sc:X (
Work Order # :? 03'-/; ~OS-b
o COMPLETE
t& INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)