HomeMy WebLinkAbout1402 S C St - Engineering
REQUEST
Date -S --/I-v S
-
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
Time? ,'LnJ ;:; IYl Received by
(phone, person)
jC/() 7 <:2.> ~s"T
Location of Work to be inspected I (c;?-- ~ L.-
Name of person requesting inspection ~~( TR,r J )) j,/
Address of person requesting inspection / 70 J 50 j] 5 T Phone No Y;). y~ 'I '7
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav (~.th;;t t t-/~ r e r
INSPECTION NOTES
Inspected Date ? - / /- (../ 5- Time
Remarks
;"7 11/ It
,(.u1 t?tA../ /,,7, c.5 e / 0v-e
.
;2 J (.) Y 11// By
v
//)
RESTORA TION REQUIRED . . . . .. YES Y NO
~ /;
C 7>:]:
<S;
\P' -
01\\ c.r f- 3S' ~ / f rA.
.-. -....
dI - r ..~
m
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
D Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC ~ Other T ~ j) 5,) I I
Work Order # ~03'-1b"", 0/')
o COMPLETE
% INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)