HomeMy WebLinkAbout2250 W 19th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . .
REQUEST
Date '6' . I / - 0 .5
Time
Received by JdY /), vg hIS S (phone, person)
Location of Work to be inspected J J 5 () LL) I 9 IC (J 5 #"' 7
Name of person requesting inspection
Address of person requesting inspection Phone No
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
INSPECTION NOTES
Inspected ~te E3 - 11- O~
Remarks .pin,., J/-ecO. lJ..)ctf-<r
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RESTORATION REQUIRED
YES
NO X
/1 lit S7 W
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # .303 ~ c; - ;l / 2
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)