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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date C, - ? -tit
Time
7:V!74;tr
Received by
If I c... '-
(phone, .gerson)
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
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
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INSPECTION NOTES
Inspected Date C - r; - t9 I Time /;).":) # f?A By If tJ A/'
Remarks I? /f N N E Iv S E~ V,e. G '-I /l/~ TJ) T rrc-~ _ ;/fb'A- 1"1~, N
lJ c I'l P S. (" T (-; E 5" (-/( F ~ .,..
RESTORATION REQUIRED
YES
NO
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", N
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(, IV /f Tell ,.,,,, i", I I I 141'-'" Tel?
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New .7eJfv,Cc- (.I/ve
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other L /? W "it'"
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order # I rt ~
[g-COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)