HomeMy WebLinkAbout1123 Columbia St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT . . . . . . . . . . .
. . . .
REQUEST
Date I - ~ - t) / Time /0,,' --1'0 Received by R.:r:- (phone, €s~
Location of Work to be inspected / / <!'3' {'~J>...r.1/4- .:fro /~ sr. Ae~
Name of person requesting inspection ~N /"? ~~ I'Ztt!!::-
Address of person requesting inspection ~4"""l~ Phone No ~S7- 9zS"1
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other LJ~;/A16e'1
,eJeJ,e,-v6- 5--" 6v.Grl7S ~N ~ ~ nx:e. ~~ ~4>cUS.
1~ION~ofis.o/u; I ~ ~ y~.
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
D Repaired by Permittee
D No Damage Found
Work Order #
M COMPLETE /-f1-(7!
o INCOMPLETE _,
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)