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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT . . . . . .
REQUEST
Date c.f (8 r 6 5"
Time
7 A~
Received by f) <' ~;: ~'(' 5 C
(phone, person)
it...
Location of Work to be inspected I () 5~) 4-
Name of person requesting inspection De ~\ "\, \ c; P
Address of person requesting inspection Co. () Y b....~ d I '7 Cf- D Phone No c{. ( 7 - tj )] ~ q
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Type of Inspection (circle appropriate one) Permit No ~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Oth~,^- + <Z. ,.;; ~
INSPECTION NOTES
Inspected Date 4- - I (5 - 05 rime Z (J 0 1"1<< By VCllvt (<-;, C
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RESTORATION REQUIRED
YES
NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
D Asphalt D PCC D Other
Work Order # .30 '3'1"-C33
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)