HomeMy WebLinkAbout1019 S F St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date Ii? - 28 --0 7_ Time
Received by
kV
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Phone No ~~7-
Permit No
'3
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date I U .- Z 9, .--0 '2-
Remarks ceYlC:~ C?-lcw'\'3
Q~ t- S-\rE,<c2.T
( '::::::.
By
22i
;<2 V
Time
f-- S-freQ,i-
('V' U v\..--\-. cel4..t-ev-
RESTORATION REQUIRED
~ 11 c.. e.-
M 0_,/ be
NO
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opr:;1i~t~~t-~ ~;-~
t-ZVtde.v t 2 Ck\ td, e ~
YES
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel 0 Asphalt 0 PCC
o Other
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)