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CITY OF PORT ANGELES v1~IP'-\IO~
DEPARTMENT OF PUBLIC WORKS Q
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
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Time
Received by
(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
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L.c7~+--C-V
INSPECTION NOTES
Inspected Date
Remarks
Time By
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RESTORATION REQUIRED
YES
NO
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SURFACE RESTORATION.
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
o Repaired by Permittee
o No Damage Found
D Asphalt D PCC D Other
Work Order # _1 b D ~
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)