HomeMy WebLinkAbout1526 W 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . INSPECTION REPORT. . . . . .
.....
REQUEST
Date I - L.{ - 06
Time
f/tM
Received by IJ.e"U1., s E (phone, person)
/ -f(
Location of Work to be inspected /52~ tV I Z -
Name of person requesting inspection iJ~ j.{....t , ., jC
Address of person requesting inspection ~"""'..d }{......J { ! ;.... B
Type of Inspection (circle appropriate one) I
Phone No '-If 1-<{-8'-/:9
Sewer Foundation Framing
Permit No
Chimney Plumbing Final Sewer Excav Other ~~ +e r
INSPECTION NOTES
Inspected Date / - l./ - 00
Remarks R...eL'Jc.. ( :r L ". C _ r
( Z 3 '8 I!.- Z. '-5" x c.. " )
Time q,4 tvl By
M.4 ( "1. .hr~ Ie. w , + 4... 4..
tknvus E
5.5 reA.v- bA."t-d
v
RESTORATION REQUIRED
YES
NO >(
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-IL.
, VU 'Z- -
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
Cl No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # ~c)5~L '-0(..8
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)