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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date g - I ~ 0 ~
Time
7 If Jt,{
Received by D-cl/L'1 (~ C, (phone, personl
7 c.- Tt.-
Location of Work to be inspected 'D 3 &- c- ::,-
Name of person requesting inspectionJ)e......... \"7 F ,
Address of person requesting inspection ~:> rtJ V..........--",R J 7 <.>f- b Phone No +t 7 -+g '-i '7
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Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Oth~
INSPECTION NOTES
Inspected Date 23 - I - 0 5-
Remarks f,u e
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Time
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c-..<::..eu l~d I v\. To
By
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RESTORATION REQUIRED
YES
NO x:.
y ~
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 pcc
o Other
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)