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CITY OF PORT ANGELES
DEPARTMENT OF PUBL; a WORDS
........... INSPECTION REPORT ...... • • •
REQUEST:
" 19 I —Time_ f Received by (phone person)
Date _ -
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
Phone No. 4:1-1 l
Permit No.
Final Sewer Excay.
W
INSPECTION NOTES- /
inspected: gate — i > > Time BY
Remarks:_
Plumbing
...�..�.�r, w Tle%ftl oCr,1110M VFS NO
SURFACE RESTORATION:
SURFACE TYPE: ❑ Unimproved ❑Gravel
❑1 Repaired by City
❑ Repaired by Permittee
No Damaye Found
(Continue on reverse side if necessary)
❑ Asphalt ❑ PCC ❑ Other
Work Order #
❑ COMPLETE
❑ INCOMPLETE
STREET SUPERINTENDENT (DATE)
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