HomeMy WebLinkAbout1410 W 4th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST:
Date /D)7 ~~/_ Time
Received by
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"
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
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Phone No.
Permit No.
Final~r Ex~ Other
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Sewer Foundation Framing
Chimney Plumbing
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
By
RESTORATION REQUiRED...... YES'/-. NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
~ COMPLETE I~ -;LS--bO
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)