HomeMy WebLinkAbout1626 W 5th St - Engineering
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . INSPECTION REPORT . . .
.....
REQUEST
Date ID~ 25- o""Z-
Time
Received by
Rl/
(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
I~ 2b Lu S'l~
-
GCAv'( Cl/~J/l ~
Phone N05b5- /470
Permit No I V
Plumbing Final Sewer Excav Other S ,8 e uJa..1",
:~S~:~~;IO~t~OTES/f )~e/::-
;
Remarks '/ . (.
I
( /c ,,,-"/ r' r
f
-A.
,j /
r~
.Yv. I u( I l/--;: ~;lill;~141)
Time
I,.
RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
[] Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)