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..- CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date 4-(" -Dc.( Time (2-"00 fl/kl Received by Di'i1.ti/5 E. (phone, person)
Location of Work to be inspected Lm_Co{ V\.
Name of person requesting inspection be.-t"tlS 8--
Address of person requesting inspection L:1vr() Ya..rd-
Type of Inspection (circle appropriate one): f
Sewer Foundation Framing Chimney Plumbing Final
INSPECTION NOTES:
Inspected: Date 1-Co -0+
Remarks:
Phone No. </-1 7---U!l.fC;
Permit No. ~
Sewer Excav. OthCWCC: ~V-")
Time
I ~J1/l.
By
RESTORATION REQUIRED . . . . .. YES
~
\....s'
\Y
~
\j
~O'
~
NO
-J I
~ I
,
00\
\
Jef\erso,^-
Sc..L.oo t
0," A.c.
SURFACE RESTORATION:
SURFACE TYPE: D Unimproved DGravel
D Repaired by City
D Repaired by Permittee
D No Damage Found
LlA..L.)Ir;lse"'-. t?lv.d.
D Asphalt D PCC D Other
Work Order # i'-lE)Il.{ - 003
D COMPLETE
D INCOMPLETE
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