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Home My WebLink About1906 W 7th St - Building CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST 5Tit STREET. PORT ANGELES. WA 98362 ELECTRICAL PERMIT ISSUED: 6/17/2002 PERMIT NO 7702 OWNER/APPLICANT PROPERTY LOCATION CASEY & JANICE GUDGEL 1906 7TH ST W 1906 W. 7TH STREET Lot: 1&2 Port Angeles, WA 98363 Block: 2 [] Long Legal 360/452-9787 Subdivision: EVANS SUBD LOT 36 T: S: Parcel No: 063000850200000 CONTRACTOR ARCHITECT OWNER N/A VARIOUS Port Angeles, WA 99360 , 98360-0000 206/000-0000 360/000-0000 PROJECT INFO Project Type: MISC Project Value: $0.00 Occupancy Type: RESIDENTIAL Construction Type: ..~ Occupancy Group: Zoning Use: O Electrical Heat: [] Baseboard 0 KW [] Riser [] Underground Service [] Furnace 0 KW [] Overhead Service Voltage: 0 [] Heat Pump 0 KW [] TempService Phase: [] 1 [] 3 [] Fan Wall 0 KW Service Size: 200 Feeder Size: 0 PROJECT NOTES ADD 8 NEW CIRCUITS AN D UPGRADE 200 SERVICE RECEIPT #9122 FEES ASSESSMENT Service: $0.00 Additional Feeders: $0.00 Circuit Wiring: $63.20 Temp Service: $0.00 Misc Fee: $0.00 TOTAL FEE: $63.20 AMOUNT PAID: $63.20 BALANCE DUE $0.00 ('OMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MJN]MUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. DITCH ROUGH-IN / COVER SERVICE GENERAL COMMENTS: vw-1102.1s CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Zoning . . . Application valuation 03-00000933 Date 9/23/03 1906 W 7TH ST 06-30-00-8-5-0200-0000- MECHANICAL APPL. PERMIT 2468 Owner Contractor GUDGEL CASEY L/JANICER 1906 W 7TH ST PORT ANGELES WA 98363 SEKIU CHIMNEY SWEEPS P. O. BOX 573 CLALLAM BAY WA 98326 (360) 963-2864 Permit Additional desc Permit Fee Issue Date Expiration Date MECHANICAL PERMIT WOOD FIREPLACE INSERT 50.00 Plan Check Fee 9/23/03 Valuation 3/22/04 .00 o Qty Unit Charge Per Extension 1.00 50.0000 ECH ME-WOOD STOVE 50.00 -.. Permit Fee Total Plan Check Total Grand Total 50.00 ._00 ,- 50.00 50.00 .00 50.00 .00 .00 .00 .00 .00 .00 -Q ([::::> ~ Fee summary Charged Paid Credited Due flt ~ --:::::J 1- ~ -t 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 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 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. - C(-:l-3-O 3 Date Signature of Owner (if owner is builder) Date T.\PLANNING\FORMS\II02.15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO - FOUNDATION: - FOOTINGS WALLS FOUNDATION DRAINAGE - ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT # ROUGH-IN I - PLUMBING - 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 WALL / FLOOR / CEILING - MECHANICAL - . HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engmeermg DIVISIon) SEPARATE PERMIT #'s WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT SEPARATE PERMIT #'5 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 417-4653 FIRE DEPT PLANNING DEPT 4 I 7-4750 PLANNING DEPT. /(1-11-0< J . J,.. - BUILDING 417-4815 BUILDING T \PLANNING\FORMS\1102.15 [4/2002] PREPARED 10/13/03, 12 15 20 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 7 10/13/03 ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER 1906 W 7TH ST SEKIU CHIMNEY SWEEPS GUDGEL, CASEY \ 06-30-00-8-5-0200-0000- 03-00000933 MECHANICAL APPL SUBDIV PHONE PHONE (360) 963-2864 (360) 460-4771 PERMIT ------------------------------------------------------------------------------------------------ . - PERMIT: ME 00 MECHANICAL PERMIT . REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -------------------------- -------~~----------------~------------------------------------------- ""~o,~_,o/"/o,___~---~'~~::::::::;::"'::," _______~_____~~____________________ ) 1JfvV'- J "~- FOR Of/FICIAI u,~i "::> I DILle Rvc,Gj -2~"O,,:::> i rermit II: q .3 3> I J BUILDING PERMIT - APPLICATION Fill nut COMPLETELY and in INK. Your application and 5itc plan ~ruSl' BE CQMP1..ETE to be ~(:cCI)ted fOl' I'c"lew, If you han ony qUI!NtlOllS, call (lMl) 417~4815 Date: AppTllVcrl'__ . I)u~ rS8u~d:__ l -~=~~~;;;"RAe~ Phone: 11110:-[360) lfJ:) - 97S' ') Or-~6 '" r ~? City: f1urJ-./J-v1J-e (.pJ ~ Zlp:jfr3b :1 '-=,.. '? Architect/Engineer: Phone: ContractocS'~'4' rL,t'lIt rury&J~<JpSta1e T,lcense ~KIt:A:3~~xp; ~ -,~ Phon~~~"1\',: Address: City: Ztp: PROJECfADDRESS: /91'>6 W",:r! 7-1... &6" {&'3<'!s:l .:- ZONING. 1.0) d- LEGAL DESCRIPTION; Lot: } <} ~ Rlock: ~ SubdIVISIon: fEl.(JY1<.SubrO CLALLAM COUNTY PARCE~ NUMBER: Db 30&0 '8'-SCJ ~I)O Oo~ Credit Card Holder Name:_ Billing Addres.: CredIt CardType VISA Me # SIZE.'V ALVA nON: TYPE 0)" WORK: ~ $ 1"_ F. = ll' o Resldential 0 Nt:w COIlstr, l:l Re-l'Out U Stove SF. ('!I .., p o Multi-famil)' 0 Addition Cl Mov~ t:l Gill'tlgc SF rp) $ ISF. _ $ o Commercial 0 Remodel Cl Demolition 0 Deck _. _ SF @ $ ISF = $ lJ Repair 0 ::llgn 'Ii ntherg~"Q~Jfl.I$t>>l..JOTAl Vf\L )ATTO~. }$_ BRIEF DESCRIJ'l'ION O}O' TIlE PROJECT: ...tll.:'J:~C1/1 (l"s-l "'<- .::,-(Q ''n I ~ s: .o{!l ( <l-7~ @ .~ A0.'Y;" ~r C4}rn n..oy : a ) 'P-:(-Q ({ ~n120 h'.'d~.d cJCiO~ b(.f,\J I\\~ ; ~..se...+ COMMER('IALIRESJDENTIAL: Occupancy Uroup' OCclIpllnt r (lad (.;onstruOlion T;ype: No (lfStones' ~ Lot Size: _ EXIsting S{j, Fl. ,& Pl'llp(J~ed S~l Ft, _ . TOTAL S{I_Ft._ .. EXIsting lot coverage _ % & Proposed Jot cuverage ~% = 1 oli\llot COVCrilSC % _ ('UYI _ E:.:p. Date: ~4~ - RSAJWctlanrl(s); 0 Yes 0 No SEPA Checklist reqUired'! 0 Yes 0 No Other. A'PROV,\I " PLAN:_ . BLDG: _.. . DPW(f:_ ._. nUl_. O'j'HER: PLANNING USE ONLY: Dl.7ILDING PERMIT APPLICATION SllBMfT1'AL: Ihc 13uild1ng DIVISion can provide you with infomlll.hon on the applledl"'" plan subnllttal requirements If )Iou hav\: questions. VALUATION OF CONSTRIJCTIOl'i: In all "a~l!li, ij valuation lunount mnst b( entered hy lhc "ppiic~r1t. TillS figure wilT be 1\'" , 4lJ\d UGly be reVL.'led by the Building Division to comply wnh current tee schedules. Contact the Pernnr Coordluator at 417-4815 for as~ I" ,I PLAN CHECK FEE: IF a plan clled fee is due It must bt, submitted ill the lime the bUIlding permit application and con~ttllction pl.l: . ~Ilbmiltcd. A.ll other permIt fees aTe dill!: 1U tne time of pel nut IR~ance. EXPIRATION OF PLAN IU:VJEW: Tfno permit lS !!l"llctl wnlun 180 days of the date ofa/ll'iicat!on, the application will OXpll'(', ~ BUIlding Official ClII) extend the tIme for actiun hy the applies!!t lip to 180 rhl3'$ upon wl"ltten r~UC$t by the applicant (see Section 1 (: lhl.': Unifonn Build1ng Code, current edition). No applicahon can be elCtendcd more than once. 'l',IP'ORMSIAI'PS\Dliildil1l1Pcnnil Wl'd I hMJby Cttrtffy IMt I htJve read end examined this (lpplial;ltion snd know the 8E1m~ to be true and CO!'l'tct I am Buthortztd to IfJPly for this pem v understand that n is my responsIbility /0 determine what permits 6/'8 required, not the City's, an that I muqt obtain such permits prior te work, ~t"vJ Date: ~ '-' ~2 v~ 3 Applicllnt: 10"d I , I~d ~~: ~0 ~00Z-CZ-d3S ~ pORT ~ ~~~O~~ r-Gii L~ ~ "l.O{.,~ CITY OF PORT ANGELES PUBLIC WORKS - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 BUILDING PERMIT PERMIT NO: 13339 S: ISSUED: 4/08/2002 PROPERTY LOCATION 1906 7TH ST W Lot: 1 &2 Block: 2 0 Long Legal Subdivision: EVANS SUBD LOT 36 Parcel No: 063000850200000 OWNER/APPLICANT CASEY & JANICE GUDGEL 1906 W. 7TH STREET Port Angeles, W A 98363 360/452-9787 T: CONTRACTOR OWNER VARIOUS Port Angeles, WA 99360 206/000-0000 PROJECT INFO Project Value: $1,100.00 Project Type: INT. WALLS Occupancy Type: RES Occupancy Group: Construction Type: Zoning Use: ARCHITECT N/A , 98360-0000 360/000-0000 SFD Units: 0 Commercial: 0 SFD SQ FT: 0 Industrial: 0 Garage: 0 MFD Units: 0 MFD SQ FT: 0 j) C) tP PROJECT NOTES ADD INTERIOR WALLS AND BATHROOM RECEIPT#8934 FEES ASSESSMENT Building Permit: Plan Check: State Surcharge: House Moving: Manufactured Home: Sign: Plumbing: Mechanical: Radon: E $41 .80 $0.00 $4.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Misc Fee 1: Misc Fee 2: Misc Fee 3: -1 +- ) $0.00 $0.00 $0.00 TOTAL FEE: AMOUNT PAID: BALANCE DUE: $46.30 $46.30 $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 180 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 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. Signature of Contractor or Authorized Agent Date BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT # -,"""?D z.. ROUGH-IN 6-1.5-Q2 IAGO PLUMBING UNDER FLOOR / SLAB ROUGH-IN ~-b-O,- LEH WATERLINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS ~I ~b ,_- IJ-U- CEILING 7 I '........ '( FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING ~-b--6Z. /Iff DRYWALL T-BAR INSULATION SLAB / I I ,. WALL / FLOOR / CEILING V lJ:)/ ?rJ1D5 1[,.b."/4./.. MECHANICAL HEAT PUMP WOODSTOVE / PELLET/CHIMNEY / INSERT HOOD/DUCTS PW UTILITIES / SITE WORK (Engineenng 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 ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R W / PW I CONSTRUCTION - R W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 > "t/)J r.p -d PLANNING DEPT BUILDING 417-4815 ~~-~~ .k]\j BUlLDING C \APPL WPD BUILDING PERMIT - APPLICATION The Building Permzt ApplicatIOn must be filled out completely. Please type or print in ink. If you have any questions, please call 417-4815 Applicant or Agent:C Phone: Lf52~ 918' '7 Owner: Ca6 €-I Phone: Lf s,~ - q ') ~? City:+6rt /~ n3eJe~ Zip: 9~;)h~ "'lJ&LIC~ Address: Architect/Engineer: Contractor ()u..J-eMr Phone: License #: Exp: Phone: Address: City: Zip: PROJECT ADDRESS:!q (j (p UJ ~61:: I tn WNING: LEGAL DESCRIPTION: Lot: ,-z.. Block: 'Z- ~ Subdivision: €l/~ Su8.i) ~r3lo CLALLAM COUNTY PARCEL NUMBER: I.H....3ooo1f~'2.00 edit Card Holder Name: Billing Address: City: Credit Card #: Exp. Date: VISA MC TYPE OF WORK: SIZENALUATION:' Jb ____ o Residential 0 New Constr. 0 Re-roof 0 Wood-stove SF. @$ /SF. ='1;/ CJ6 o Multi-farmly 0 Addition 0 Move 0 Garage SF. @ $ /SF. = $ o Commercial WRemodel 0 Demolition 0 Deck SF. @ $ /SF. = $" o Reparr 0 Sign 0 TOTAL VALUATION $ -t:1::.~ . '$0 .p'I~ BRIEF DESCRIPTION OF THE PROJECT: ~ /' COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type: % /sq. ft. = TOTAL LOT COVERAGE: APPROVALS: PLAN BLDG. DPW FIRE ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: OTHER BUILDING PERMIT APPLICATION SUBMITTAL: Your application and site plan must be filled out completely to be accepted/or review. The Building Division can provide you with more detailed mformatlOn on the application and plan submittal requirements. Your completed application, SIte plan (for additions) and building construction plans are to be subrmtted to the Building DiVIsion. No. of Stories. _ Lot SIZe: Existing Lot Coverage: PLANNING USE ONLY: Notes: % Lot Coverage: /sq. ft. + Proposed Lot Coverage: /sq. ft. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applIcant. This figure will be revIewed and may be revised by the Budding Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: Your plan check fee is due at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: If no permit is Issued within 180 days of the date of application, thIs application will expire. The Building Official can extend the time for action by the applIcant up to 180 days upon wfltten request by the applicant (see Section 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby certify that I have read and examzned this application and know the same to be true and correct, and I am authorized to apply for this permzt. I understand zt is not the City's legal responsibzlity to determine what permits are required, it remains the applicant's responszbzlzty to determine what permits are requzred and to Obta~in uch. ~ Applicant: ~~ -Jjl1Jr1 Date, rj-;r-O:2 T \FORMS\APPSIBU\ldmgpenmt _ , r __ , '''' ..c_ '___ .,'. ' .( , .'{ OF PORT A~GELES_ ,-,.co!'strlJ.ction Plans ___the Issu~nce of this permit based upon these plans~ speafl' : lu _ - .-P.... :. . - .____~~-.. p. - p.~' m ,,'m,; .,d ,..i d." """ 001 ....""" "'Mm, -, ',.__ .~, < . ,'._.., .. __ __ __ .- ." ,-,,' ,-- ,.,-, . .-< '- ".'~". 'ftom< thereafter requiring the- correcbon of errors Jrl,S~lllt. ,-.:' ~ :!ifij)f~~i~i~,-, ,W 1-_'_'. I . " -- .' -'- .. . -... --" ,,'. ,-. -...-- .plans, spaclflcatljlnL a~d other data, or from preventing , r r ' . ]'" _<<, ,,_. P.___,_ _..., _. _._<<._ _. .. ___, __",'._ ' 'building operabons being earned'on- tIleiiunaer wlien in : - - ;'_' ,t'l',;_J-,f~~._-'-. ,I)',7r,'"",'. ',,-,. .. :' -- :'-:'r':!~:.~':~~:,- .-,~ "'" -/IL.-&.;L,,~_..---_.--_.. ,__ "': ---...---:.--r------.vrolationorallcod~amj-o~dinaneesot.tht$-jurisdil:boD.-c.-,., . ,lfP '." , __ --t' -4".- ',_" _ __ '''''' '_,_ ,_, ".. ___,__n.., ._1......: ,__ ,____ _ __~,~ ,- -. 1-' " a-II - ,II .,- '-.ISteTION 303(&)., UnifOtmJ~wtdmg Code.) ,- , _/I 7' :-:'.:-C-:-~:-C-:-~ ~p.=:="'. ".' -- .......alllIIe 4'-8 -CZBJ . Lctf p ,.p .... r'- -.- <<- ,- .--, -- -, " .--" '- --..- ...--..' 1 ." '--..' ---..-:-::-:::'-,..-;-.-::::--:"":--.::::---:~-:-::-.::~l1,. , ,.-.,..,.,.-" ....1,_.__ .. .. . -- -f - ..."---..,!. .. ------' ;: " _' . _" ,,_" , .__,,_, __ _ __., _ __ ,__. . ",' .___ ..~,_ .,,__..__._ ,...1. 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' .' ~ -.'\'1-- , .;/'l-.q__c:i~:F:f. . __ < ~ C~ey- +1:J:~t1;(e -- 0~ ,-J .. -., ,- -- ' .. ... . ~l~l~.: ~t#~~lltlJffJ~~77 i ,:.__~'~~X:':Jf~: '~'~'.':' ~~',:'__~ T~'~ '.~' e ){ ~~jj!., . -- -- ", -~-- - -;--- CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date .5 - ~ -- <J~ Av' Time Received by Rv (phone, person) /0 b LV (-f lit Location of Work to be inspected I () Name of person requesting inspection C-c...s.lC..... 'I Address of person requesting inspection ::~e:f 1;::::::i:~Cir;:~in~:pri::::::I~m~ Final OlA~~-r~ INSPECTION NO~!S:~ / \ " _~ f: ./) 11 Inspected: Date ,_/' 10 Ii .-" , Remarks: Phone No. t; 6() - LIt? , Permit No. 13?53cy Sewer Excav. Other >f Time By /> /;,~) V f / r' \,. . RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: D Unimproved D Gravel D Asphalt D PCC o Other D Repaired by City D Repaired by Permittee D No Damage Found Work Order # o COMPLETE D INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST: Date t-,-26 -- t> '2.... Time Received by f2:V (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing /900 W QClSJ2Y 7"-l-J Phone No. '1f:JJ -'-I77i Permit No. IsSS_ Final Sewer Excav. Other A J r SQQ., l INSPECTION NOTES:?- ft- Inspected: Date ~ c Zlr.. () ~ Remarks: Time By ~ R /~~7 ~~ ~ ( /) ~ "- t ~" /-,;-Y /.ry f"'''= " v RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: D Unimproved D Gravel D Asphalt D PCC D Other D Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE D INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)