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Home My WebLink About2316 S Chase St - BuildingPREPARED 12/14/10 8 24 40 INSPECTION TICKET PAGE 11 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 12/14/10 ADDRESS 2316 S CHASE ST SUBDIV TENANT NBR GARY E WARREN CONTRACTOR ALL WEATHER HTG COOLING INC PHONE (360) 452 9813 OWNER GARY E WARREN PHONE (360) 452 4398 PARCEL 06 30 10 5 0 1948 0000 APPL NUMBER 10 00001285 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME99 01 12/14/10 MECHANICAL FINAL TIME 01 00 December 13 2010 8 37 23 AM 1pangrle JENNY (ALL WEATHER HTG 452 9813) MECHANICAL FINAL HEAT PUMP AFTERNOON COMMENTS AND NOTES Date rayYllcaclon Numner Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc DUCTLESS HEAT PUMP INSTALLATION Owner GARY E WARREN 2316 S CHASE ST PORT ANGELES (360) 452 4398 Permit MECHANICAL PERMIT Additional desc DUCTLESS HEAT PUMP Permit pin number 176743 Permit Fee 64 80 Issue Date 11/02/10 Expiration Date 5/01/11 Qty Unit Charge 1 00 Fee summary Permit Fee Total Plan Check Total Grand Total 14 8000 EA Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work has commenced or if required inspections have not been requested within 180 days from the last inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction /2 0 S in 0l[ h ow►-, 7 T Forms /Building Division /Building Permit CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 WA 983626520 Per Charged 64 80 00 64 80 lU UODUJ2 5 251820 2316 S CHASE ST 06 30 10 5 0 1948 0000 GARY E WARREN MECHANICAL APPL PERMIT RS7 RESDNTL SINGLE FAMILY 5805 Contractor ALL WEATHER HTG COOLING INC 302 KEMP ST PORT ANGELES WA 98362 (360) 452 9813 Plan Check Fee 00 Valuation 0 BASE FEE ME FURN /HP /FAU OR 5 TON Paid Credited 64 80 00 00 00 64 80 00 Print Name Signature of Contractor or Authorized Agent Lace 11/U2/1U Due Extension 50 00 14 80 00 00 00 REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) 6irla 'el)! l2 IHllo Signature of Owner (if owner is builder) FOUNDATION Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs PLUMBING Under Floor Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow Water AIR SEAL. Walls Ceiling FRAMING Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall Floor Ceiling MECHANICAL. Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting T Forms /Building Division /Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS Building Inspections 417 4815 Electrical Inspections 417 4735 Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED POST PERMIT IN CONSPICUOUS LOCATION KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments IFINAL Date 1 PLANNING DEPT Separate Permit #s SEPA. Parking Lighting I I ESA. Landscaping 1 1 SHORELINE. FINAL Date Accepted by 1Z-^1 Acceepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 Date Accepted By Z0 /Z0 39tid Parcel Number BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn: Building Permit Technician 321 E. Fifth St. Port Angeles, WA 98362 (360) 417 -4815 fax (360) 417 -4711 Applicant .41 Q1 Phone Property Owner It 1. T ilitt H 7 1 nni t I A Phone Property Owner's Addres 2 4p Contractor WtZ kliLoarc, CDC ui'� G Contractor's Address 3DD Stre4 1 License# G .\F-CD 1U1. Expires WI11 E -mail PROJECT ADDRESS 2 l-p S. aho S Protect Tvoe Brief Descriation. Residential Multi- family o Commercial Check all that apply New Construction a Addition Remodel o Repair n Demolition n Re -roof J-leat System o Other ',AKA-1 ass NCA-N Floor Areas Existing (sq. ft) loosed (sq. ft.) Basement per sq. ft. 1 Floor 2 Floor 3 Floor Garage Carport Covered Porch Deck Shed Other Max. height of proposed structures ft. Occupancy group Will a lawn sprinkler system be installed? Occupant Toad Will a.fire sprinkler system be installed? Construction type Phone Lot For City Use Only Date Received Permit j0-IZj Date Approved Zoning House o garage other o tear off re -roof o lay over one layer *Heat pump n wood buming stove a gas fireplace o pellet stove NQ otherN,11 TOTAL VALUATION i P 0 Total footprint of structures sq. ft. T Lot size sq. ft. Lot coverage aCC)- ..c3S1 0,t0110.0otpen ccxn c Industrial Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios, and other impervious surfaces. (see PAMC 17.94 135 for exemptions) Site coverage of bedrooms of full baths of half baths I have read and completed this application and know it to be true and correct. 1 am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior ta►'reiking on protects. Date A I1 110 Print Name h Signature l 'f FormslBullding Division /Bldg Permit.doc �J 1 9NI1ti3H 2l3H1 /'1 11V �LTSZSb0SET 0T 60 0T0Z Z0 /TT Clallam County Assessor Treasurer Property Details 65107 GARY E WARREN for Page 1 of 6 Clallam County Assessor Treasurer Property Search Results 65107 GARY E WARREN for Year 2010 2011 Property Account Property ID' Geographic ID 0630105019480000 Agent Code Type. Real Tax Area: 0010 PA 121 PORT ST CNTY H2 L Land Use Code 11 Open Space N DFL N Historic Property' N Remodel Property' N Multi Family Redevelopment: N Township Section. Range Location Address. 2316 S CHASE ST Mapsco PORT ANGELES WA Neighborhood: Cycle 5 Res Map ID 2 Neighborhood CD' 10955130 Owner Name GARY E WARREN Owner ID' Mailing Address: 2316 S CHASE ST Ownership. PORT ANGELES WA 98362 -6520 Taxes and Assessment Details Property Tax Information as of 11/02/2010 Amount Due if Paid on. M. 65107 Legal Description. PUGET SOUND CO -OP COLONY 2 ADD N2 LOTS 18 -20 BL 19 Exemptions 58438 100 0000000000% NOTE If you plan to submit payment on a future date make sure you enter the click RECALCULATE to obtain the correct total amount due. First Second Half Half Base Base Year Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid p i 2010 47367 ST SCH STATE SCHOOL $152.96 $152 97 $0 00 $0 00 $305 93 2010 47367 CC -GEN COUNTY $81 39 $81 42 $0 00 $0 00 $162.81 2010 47367 PORT PORT $11 44 $11 44 $0 00 $0 00 $22.88 2010 47367 PORT ANG PORT ANGELES $188 47 $188 48 $0 00 $0 00 $376 95 2010 47367 SD #121 SCHOOL DISTRICT #121 $198 13 $198 13 $0 00 $0 00 $396.26 12010 47367 NTH OLY LIB NORTH OLYMPIC LIBRARY $23 66 $23 65 $0 00 $0 00 $47 31 2010 47367 HOSP #2 HOSPITAL #2 $33 40 $33 39 $0 00 $0 00 $66 79 2010 47367 WSMET PK DIST WILLIAM SHORE MET PARK DIST $10 62 $10 63 $0 00 $0 00 mm $21.25 2010 47367 CITY_STORMWATER CITY STORMWATER $36 00 $36 00 $0 00 $0 00 $72.00 2010 47367 WEED_CONTROL WEED CONTROL $0 82 $0 81 $0 00 $0 00 $1 63 2010 47367 TOTAL. $736.89 $736.92 $0.00 $0.00 $1473.81 2009 651072008 ST SCH STATE SCHOOL $173.27 $173.27 $0 00 $0 00 $346 54 2009 651072008 CC -GEN COUNTY $87 69 $87 69 $0 00 $0 00 $175 38 2009 651072008 PORT PORT $12.42 $12.42 $0 00 $0 00 $24 84 2009 651072008 PORT ANG PORT ANGELES $192.34 $192.35 $0 00 $0 00 $384 69 http. /vpn. clallam. net. 8084 /propertyaccess /Property. aspx ?cid =0 &year= 2010 &prop_id =65 11/2/2010 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 0 Application desc Ductless heat pump Owner WARREN GARY E 2316 S CHASE ST PORT ANGELES Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summary Permit Fee Total Plan Check Total Grand Total WA 983626520 ELECTRICAL HEATPUMP 176503 78 70 11/01/10 4/30/11 Signature of owner or Electrical Contractor X ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 10 00001269 496990 2316 S CHASE ST 06 30 10 5 0 1948 0000 ELECTRICAL ONLY Contractor SIMPSON ELECTRIC 243036 W HWY 101 PORT ANGELES (360) 457 9270 Qty Unit Charge Per 1 00 73 5000 ECH EL BRANCH CIRCUIT WO /FEEDER 2 00 2 6000 ECH EL ECH ADDNT BRANCH CIRCUIT Charged Paid Credited 78 70 78 70 00 00 00 00 78 70 78 70 00 INSPECTION TYPE DATE. DITCH SERVICE ROUGH IN FINAL COMMENTS PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Date 11 /01 /10 WA 98363 Plan Check Fee 00 Valuation 0 Extension 73 50 5 20 Due 00 00 00 RESULTS INSPECTOR. ro=ip .47 ye. REPORT STATE SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) Date or t ra It Contrac/or Inform Name: Mailing A s. City: Phone: 1 eo CITY OF PORT ANGELES PERMIT APPLICATION Building Division Inspections 321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 Ph..(360) 417 -4735 Fax: (360) 417 4711 Date: 10 -J0 1 2 Single Family Dwelling Multi Family or Commercial* Commercial Addition Alteration Remodel Repair* Plan Review May Be Required, Ple s mplete Electrical Plan Review information. Sheet Job Address: OCT 2 3 2:L3 ELECTRICAL INSPECTIONS Building Square Footage: option of above Owner G er Info ation Name: x ley E /c -�'at Mailing A� re C B t J ai 0 City State: Zip: `t Fab State: Phone' .t'ii Fax. Fax: License d Exp. License $1/Exp. flP5 ezi....9.7_; yI er? Item Unit Charge fLI.. Total f,3ttr Multi plied by Unit Charoe], Service /Feeder 2.00 Amp, 119.90 Service/Feeder 201-400 Amp. 145.50 Service /Feeder 401.600 Amp 204.60 Service Feeder 601 -1000 Amp, 262.20 Service/Feeder over 1000 Amp. 372.50 Branch Circuit W/ Service Feeder 2.60 Branch Circuit W/O Service Feeder 73.50 1 7J, 5 5 Each Additional Branch Circuit 2.60 7 4 2_ Temp. Servico/ Feeder 200 Amp. 92.70 Temp. Service /Feeder 201 -400 Amp. 110.30 Temp. Service/Feeder 401 -600 Amp. 148.70 Temp, Service /Feeder 601 -1000 Amp 167.90 Portal to Portal Hourly 95.90 Sign /Outline lighting 88.20 Signal Circuit/ Limited Energy First 1500 sf Commercial 95.90 Note: $5.00 for each additional 1500 sf Signal Circuit/ Limited Energy 1 2 Family Dwelling 63.90 Signal Circuit/ Limited Energy Multi- Family Dwelling 63.90 Manufactured Home Connection 119.90 Renewable Electrical Energy 5KVA System or Less 102,30 Thermostat 56.00 NEW CONSTRUCTION ONLY. First 1300 Square Ft, 110.30 Each Additional 500 Square Ft. or Portion of $95.7.0 Each Outbuilding or Detached Garage 73.50 Each Swimming Pool or Hot Tub 110.30 7t ?Total Owner as defined by RCW 19.28.261 (1) Owner will occupy the structure for two years after this electrical permit is finalized. Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last Inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical cor tractor I am making the electrical installation or alteration In compliance with the electrical laws, N.E.C. RCW Chapter 19.28. WAC. Chapter 296 -4 36, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. SI, t e of owner electrical corj1ractor or electrical administrator D Cm* 0 Cheek kJ Credit Cana 0 817A �i .r a Dated: /6 ,Z9 —.jO 0110112010 a~.,~,r · CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILD1NG DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 I~IJIL. IJII~I~ ~t't~ll~lll ISSUED: 10/14/2002 PERMIT NO: 13759 OWNER/APPLICANT PROPERTY LOCATION 2316 CHASE S GARY WARREN 2316 S CHASE STREET Lot: N 1/2 18-20 Port Angeles, WA 98362 Block: 19 [] Long Legal 360/000-0000 Subdivision: PSCC 2ND ADDNT. T: S: Parcel No: 063010501948000 CONTRACTOR ARCHITECT ANGELES SERVICE CENTER N/A 56585 HWY 112 Port Angeles, WA 98363 , 98360-0000 360/928-3098 360/000-0000 PROJECT INFO Project Value: $11,800.00 SFD Units: 1 Commercial: 0 Project Type: POLE GARAGE SFD SQ FT: 999 Industrial: 0 Occupancy Type: RESIDENTIAL Garage: 828 Occupancy Group: MFD Units: 0 Construction Type: MFD SQ FT: 0 Zoning Use: PROJECT NOTES CONSTRUCT a 23' X 36' DETACHED POLE BLD./GARAGE RECEIPT#9815 FEES ASSESSMENT Building Permit: $209.25 Misc Fee 1: $0.00 Plan Check: $83.70 Misc Fee 2: $0.00 State Surcharge: $4.50 Misc Fee 3: $0.00 House Moving: $0.00 Manufactured Home: $0.00 Sign: $0.00 TOTAL FEE: $297.45 Plumbing: $0.00 AMOUNT PAID: $297.45 Mechanical: $0.00 BALANCE DUE: $0.00 Radon: $0.00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within t 80 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and knew the same to be true and correct. All previsions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authgrity to vio~a~ or c~,~el the provisions of any state or local law regulating construction or the performance of construction. / // // Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\PLA~BG\FOPJq$\] ] 02. I $ [4/2002[ BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT 1N A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE I DATE I YEsACCEPTEDI NO COMMENTS FOOTINGS i ~ ~ ~t,~ -'~'~ J~I~P~ WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # PLEMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING DRYWALL T-BAR INSULATION SLAB I WALL / FLOOR / CEILING MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Enginee~ng Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMit #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 4 I7-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 [ [ -- '~.~-- ~.~- ~'~E/~] BUILDING T:\PLANNING\FORMS\1102.15 [4/2002] pORTANGELES WASHINGTON, U.S.A. DEPARTMENT OF COMMUNITY DEVELOPMENT August 7, 2002 TO: Trenia Funston, Public Works and Utilities '~E76~ Haehnlen, Building Division DCD Ken Dubuc, Fire Department FROM: Sue Roberds, Assistant Planner SUBJ: VARIANCE - VAR 02-05 WARREN - 2316 South Chase Street Attached is an application to allow a decrease in the rear yard setback from 10' to 3' to allow a detached garage in the RS-7, Residential Single Family zone. Please review the application and return your comments no later than August 15.2002. Attachments BUILDING PERMIT- APPLICATION P~t,: i~.~' Date Approwd: Date Issued: The Building Permit Applicaaon must be filled out COm~letely, Please ~pe or print in ink. If you have any questions, please call 417-4815 Applic~t or Agent: ~t ~ ~oc~e~ ~ ~c~ Phone: q Z ~ 3 o ~ Owner: ~g ~tt~ Phone: MchitecffEngineer: q ~o~ ~ Phone: Contractor ~ ~5~ ~o,~icense~:~cg~3olExp: ~-0~ Phone: ~¢~5og~ PROJECT ~D~SS: 'L 3 IG ~ ~$~ ~NG: ~ 3 ~ LEGAL DESC~PTION: ~15- Zo Block: I~ Subdivision: fo~an ~o C~eCo~ovy CL~L~ CO~TY P~CEL N~BER:~6i~ Iff~ ~ Credit Card Holder Name: Billing Address: City:, Credit Card g: Exp. Date: VISA MC T~E OF WO~: SIZE~UA~ON: D Residential ~ New Co~. D Re-roof ~ Wood-stove ~'~ ~ SF. ~ $_ /SF. =$ ~ Multi-fa~ly ~ Ad~tion ~ Move ~ G~age SF. ~ $. /SF. = $ ~ Comercial ~ Remodel ~ Demolition ~ Deck SF. ~ $_ /SF. = [ ~ R~air ~ Sign ~ TOT~ VALUATION $ ~'~ COM~RCI~SIDENT~: Occupancy Group: Occupant Load: ~ Com~cOon T~e: No. of Stories: t Lot Size: /o5o~ % Lot Coverage: [ 7 % Existing Lot Coverage: t OoO /sq. ff. + Proposed Lot Coverage: ~Z Y /sq. ff. = TOTAL LOT CO~GE: /~ Z ~ /sq. ff. PLANING USE ONLY: ~PROV~S: PL~ Notes: BLDG. DPW FI~ ES~etland(s): D Yes ~ No SEPA ~ec~ist requked? ~ Yes D No O~er: OTHER B~LDING PE~IT ~PLICATION SUBMITT~: Your application and site plan must be filled out comp&rely to be accepmd for rev~w. The Building Division can provide you wi~ more detailed ~omtion on the application ~d pl~ sub~Ral requkements. Yo~ co~leted application, site plan (for addifiom) and build~g cons~ction plans are to be sub,Red to ~e Buil~ng Division. V~UATION OF CONSTRUCTION: In all cases, a valuation amount mast be entered by ~e applic~t. This fi~re will be reviewed and ~y be revised by ~e Building Division to c o~ly wi~ cu~ent fee schedules. Contact ~e Pe~t Coord~tor at 417-4815 for assistance. PL~ CHECK FEE: Yo~ plan check fee is due at the time the building pe~t application and com~ction plato ~e subdued. All other pe~t fees are due at ~e time ofpe~t issuance. EXPIATION OF PL~ ~VIEW: If no pe~t is issued ~thm 180 days of~e date of application, ~s application will expire. ~e Building Official can extend ~e t~e for action by ~e applicant up to 180 days upon ~i~en request by ~e applicant (see Section 107.4 of th~ Unifom Building Code, cu~ent edison). No application can be extended more than once. [ hereby cert~ that [ have read and examined this application and know the same to be ~e and comect, and I am authorized to apply for this permit. I understand it is not the Ci~'s legal responsibili~ to dete~ine what permits are required; it remains the applicant's Applicant: ~~ ~ Date: ~O-Z -o~ CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~ Time Received by ~ (phone, person) Location of Work to be inspected 2 ~ ~ ~-~ ~ Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer ~on Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: ~'~--~ ...... Inspected: Date ,J~ ' ' ~ ~' Time By Remarks:. RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved []Gravel [~Asphalt [-~PCC []Other [] Repaired by City Work Order # [-1 Repaired by Permittee [] COMPLETE [] No Damage Found [] INCOMPLETE {Continue on reverse side if necessary} STREET SUPERINTENDENT {DATE} CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... RE GU E~. '.~ ..~/~ e~ Date / .., '~-- Time // ~ /~/~Received by ~S.~ ~ (phon ' Location of Work to be inspected _~//~ -~'. ~"~ Name of person requesting inspection ~.~ // ~-Y' ~.'C~/d-~-~/~! //F/,'//~o y. Address of person requesting inspection _~-~,~ ~ Phone No.,~/~-~ Type of Inspection (circle appropriate one): Permit No. /~_-~' Sewer Foundation Framing Chimney Plumbing ~ Sewer Excav. Other INSPECTION NOTES: Inspected: Date ,///~ ~ ~/~-- Time By Remarks:. RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved []Gravel []Asphalt []PCC []Other [] Repaired by City Work Order # [] Repaired by Permittee [] COMPLETE ~-] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)